Provider Demographics
NPI:1790713923
Name:SCHRODE, MARC D (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
Last Name:SCHRODE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36100 EUCLID AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4456
Mailing Address - Country:US
Mailing Address - Phone:440-951-8360
Mailing Address - Fax:440-951-9408
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4456
Practice Address - Country:US
Practice Address - Phone:440-951-8360
Practice Address - Fax:440-951-9408
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004757207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0782461Medicaid
OH100650OtherKAISER
OH2500801OtherUNITED HEALTHCARE
OH000000132619OtherANTHEM BLUE CROSS/BLUE SH
OH4326064OtherAETNA
OH341487428OtherTAX ID
OH060030888OtherRAILROAD MEDICARE
OH51701OtherQUALCHOICE
OH000000132619OtherANTHEM BLUE CROSS/BLUE SH
OH2500801OtherUNITED HEALTHCARE