Healthcare Provider Details

I. General information

NPI: 1366818866
Provider Name (Legal Business Name): RICHARD SCHOEWE MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 RICE ST
ROSEVILLE MN
55113-3715
US

IV. Provider business mailing address

2381 RICE ST
ROSEVILLE MN
55113-3715
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-9722
  • Fax: 651-482-9091
Mailing address:
  • Phone: 651-482-9722
  • Fax: 651-482-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD W SCHOEWE
Title or Position: OWNER
Credential: MD
Phone: 651-482-9722