Provider Demographics
NPI:1912095324
Name:SCHUCKMANN, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SCHUCKMANN
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 1:237 WILLIAM HOWARD TAFT, PHYS. DIV.
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-351-9900
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:5885 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1720
Practice Address - Country:US
Practice Address - Phone:513-333-3338
Practice Address - Fax:513-564-3836
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000818213E00000X
OH2842213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0778699Medicare PIN
OH4015854Medicare PIN
IN172670Medicare PIN
IN132710Medicare PIN
OH0778698Medicare PIN
OH4047295Medicare PIN
OH4015855Medicare PIN