Provider Demographics
NPI:1194105502
Name:MILES D. SCHROEDER AND GERALYN M. SCHROEDER, P.C.
Entity type:Organization
Organization Name:MILES D. SCHROEDER AND GERALYN M. SCHROEDER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-897-8028
Mailing Address - Street 1:8028 E 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5242
Mailing Address - Country:US
Mailing Address - Phone:317-897-8028
Mailing Address - Fax:317-897-8025
Practice Address - Street 1:8028 E 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5242
Practice Address - Country:US
Practice Address - Phone:317-897-8028
Practice Address - Fax:317-897-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73811223G0001X
IN76581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1447397765OtherNPI
IN200190760AMedicaid