Healthcare Provider Details

I. General information

NPI: 1841265667
Provider Name (Legal Business Name): CHARLES ERIC SCHROEDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKE'S BLVD 3RD FLOOR
LEE'S SUMMIT MO
64086
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-5128
  • Fax: 816-347-5351
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04-19418
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2023043863
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: