Healthcare Provider Details

I. General information

NPI: 1972024800
Provider Name (Legal Business Name): MARY SCHROTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LOWE

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11091 JASON AVE NE
ALBERTVILLE MN
55301-4699
US

IV. Provider business mailing address

1700 HIGHWAY 25 N
BUFFALO MN
55313-1930
US

V. Phone/Fax

Practice location:
  • Phone: 763-684-8300
  • Fax:
Mailing address:
  • Phone: 763-682-1313
  • Fax: 763-581-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.071528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: