Provider Demographics
NPI:1174709083
Name:MARK SCHROER MD PLLC
Entity type:Organization
Organization Name:MARK SCHROER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-431-8285
Mailing Address - Street 1:17 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1803
Mailing Address - Country:US
Mailing Address - Phone:859-431-8285
Mailing Address - Fax:
Practice Address - Street 1:17 E 6TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1803
Practice Address - Country:US
Practice Address - Phone:859-431-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100019140Medicaid
KY00543OtherMEDICARE PTAN