MEDICARE: DOUGLAS SCHUCKMANN 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	213E00000X	Podiatrist	07000818	IN
2	213E00000X	Podiatrist	2842	OH

General Provider Information

NPI Number	:	1912095324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS SCHUCKMANN MD

Provider Business Mailing Address
First Line	:	237 WILLIAM HOWARD TAFT, PHYS. DIV.
Second Line	:	2ND FL, CBO2-3, ATTN: CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:	513-351-9900
Fax Number	:	513-366-4480

Provider Business Practice Location Address
First Line	:	5885 HARRISON AVENUE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1720
Country	:	US
Telephone Number	:	513-333-3338
Fax Number	:	513-564-3836

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/22/2020

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