Provider Demographics
NPI:1972582799
Name:SCHOETTINGER, TED J (MD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:SCHOETTINGER
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 1:67 NUNNER RD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039
Mailing Address - Country:US
Mailing Address - Phone:513-677-2405
Mailing Address - Fax:513-677-0734
Practice Address - Street 1:67 NUNNER RD
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039
Practice Address - Country:US
Practice Address - Phone:513-677-2405
Practice Address - Fax:513-677-0734
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064418S207Q00000X
OH35.064418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6441803OtherHUMANA
OH0103828OtherUHC
OH0979133Medicaid
OH1575148Medicaid
OH000000335394OtherANTHEM
OH4374020OtherAETNA
OH1575148Medicaid
OHSC7324731Medicare ID - Type Unspecified
OH0103828OtherUHC