Healthcare Provider Details

I. General information

NPI: 1972582799
Provider Name (Legal Business Name): TED J SCHOETTINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 NUNNER RD
MAINEVILLE OH
45039
US

IV. Provider business mailing address

67 NUNNER RD
MAINEVILLE OH
45039
US

V. Phone/Fax

Practice location:
  • Phone: 513-677-2405
  • Fax: 513-677-0734
Mailing address:
  • Phone: 513-677-2405
  • Fax: 513-677-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35064418S
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.064418
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: