Provider Demographics
NPI:1225023526
Name:SCHRADER, AGNES J (MD)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:J
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:R
Other - Last Name:JOHENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9011 N MERIDIAN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5365
Mailing Address - Country:US
Mailing Address - Phone:317-564-2134
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:165 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1310
Practice Address - Country:US
Practice Address - Phone:317-773-0363
Practice Address - Fax:317-770-8910
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043194A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200000930Medicaid
IN200000930Medicaid
F55988Medicare UPIN
IN390005172Medicare PIN