Provider Demographics
NPI:1588668818
Name:SCHUSTER, BRYCE E (MD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:E
Last Name:SCHUSTER
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 1:2100 GARDINER LN STE 207
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2948
Mailing Address - Country:US
Mailing Address - Phone:502-777-9961
Mailing Address - Fax:502-379-8791
Practice Address - Street 1:1 AUDUBON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-777-9961
Practice Address - Fax:502-379-8791
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063466A208600000X
KY39250208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000362178OtherANTHEM
IN201260320Medicaid
KY64098676Medicaid
KY000000362178OtherANTHEM
KYI26091Medicare UPIN
KY64098676Medicaid
ININ1888001Medicare PIN