Provider Demographics
NPI:1023014479
Name:SCHULD, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:SCHULD
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 1:7500 STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:RILEY
Mailing Address - State:IN
Mailing Address - Zip Code:47871
Mailing Address - Country:US
Mailing Address - Phone:812-894-2304
Mailing Address - Fax:812-894-3604
Practice Address - Street 1:7500 STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:RILEY
Practice Address - State:IN
Practice Address - Zip Code:47871
Practice Address - Country:US
Practice Address - Phone:812-894-2304
Practice Address - Fax:812-894-3604
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045428A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200046840BMedicaid
ING16065Medicare UPIN
IN215940AMedicare PIN