Provider Demographics
NPI:1962428276
Name:SCHADLU, RAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:SCHADLU
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 1:3840 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5917
Mailing Address - Country:US
Mailing Address - Phone:602-232-6066
Mailing Address - Fax:
Practice Address - Street 1:3840 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5917
Practice Address - Country:US
Practice Address - Phone:602-232-6066
Practice Address - Fax:602-314-4154
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005008908207W00000X
PAMD435175207W00000X
AZ41415207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ473420Medicaid
MO207306705Medicaid
929810103Medicare PIN
P00250921Medicare PIN