Provider Demographics
NPI:1750612503
Name:SCHLAGETER, CARL SETFORD (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:SETFORD
Last Name:SCHLAGETER
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 1:612 E ROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286
Mailing Address - Country:US
Mailing Address - Phone:618-443-3234
Mailing Address - Fax:618-443-3234
Practice Address - Street 1:612 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1818
Practice Address - Country:US
Practice Address - Phone:618-443-3234
Practice Address - Fax:618-443-3234
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036038732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000000000OtherNONE