Healthcare Provider Details

I. General information

NPI: 1215969936
Provider Name (Legal Business Name): ERIK L SCHROEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SUNNYVIEW LN
KALISPELL MT
59901-3164
US

IV. Provider business mailing address

111 SUNNYVIEW LN
KALISPELL MT
59901-3164
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-7900
  • Fax: 406-257-0253
Mailing address:
  • Phone: 406-752-7900
  • Fax: 406-257-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number11100
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: