Provider Demographics
NPI:1821191354
Name:SCHEEN, SAMUEL RANDOLPH III (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RANDOLPH
Last Name:SCHEEN
Suffix:III
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 1:4003 KRESGE WAY
Mailing Address - Street 2:SUITE 226
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-893-1645
Mailing Address - Fax:502-897-2338
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 226
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-893-1645
Practice Address - Fax:502-897-2338
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21343207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000358728OtherANTHEM
P00204656OtherRAIL ROAD MEDICARE
D95912Medicare UPIN
P00204656OtherRAIL ROAD MEDICARE