Provider Demographics
NPI:1790891224
Name:SCHROCK, STEVEN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DANIEL
Last Name:SCHROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W LINCOLN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5906
Mailing Address - Country:US
Mailing Address - Phone:574-319-1420
Mailing Address - Fax:574-335-0760
Practice Address - Street 1:1720 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5906
Practice Address - Country:US
Practice Address - Phone:574-319-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060333A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200526470Medicaid
IN200526470Medicaid
IN1845520003Medicare PIN
IN738460004Medicare PIN
IN738460004Medicare PIN