Provider Demographics
NPI:1215969936
Name:SCHROEDER, ERIK L (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:L
Last Name:SCHROEDER
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 1:111 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-7900
Mailing Address - Fax:406-257-0253
Practice Address - Street 1:111 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3164
Practice Address - Country:US
Practice Address - Phone:406-752-7900
Practice Address - Fax:406-257-0253
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11100207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT11100OtherSTATE LICENSE
MT1215969936Medicaid
MT1215969936OtherBLUECROSS BLUESHIELD
MT1194070001OtherCIGNA DME
P00451091OtherMEDICARE RAILROAD
MT1215969936OtherBLUECROSS BLUESHIELD
MT1194070001OtherCIGNA DME