MEDICARE: MICHAEL BENEDICT SCHNEIDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	23586	TN
2	207VM0101X	Maternal & Fetal Medicine Physician	MD204061	OR
3	207VM0101X	Maternal & Fetal Medicine Physician	MC-0632	ID

General Provider Information

NPI Number	:	1457399560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BENEDICT SCHNEIDER MD

Provider Business Mailing Address
First Line	:	3340 E GOLDSTONE DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1026
Country	:	US
Telephone Number	:	208-302-1100
Fax Number	:	208-302-1155

Provider Business Practice Location Address
First Line	:	900 N LIBERTY ST STE 206
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8729
Country	:	US
Telephone Number	:	208-302-1100
Fax Number	:	208-302-1155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/21/2022

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