Healthcare Provider Details

I. General information

NPI: 1821997883
Provider Name (Legal Business Name): AUSTIN MICHAEL SCHROEDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DERR RD
SPRINGFIELD OH
45503-2439
US

IV. Provider business mailing address

1004 TERRACEWOOD DR
ENGLEWOOD OH
45322-2456
US

V. Phone/Fax

Practice location:
  • Phone: 937-629-0100
  • Fax: 937-629-3285
Mailing address:
  • Phone: 937-681-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010772RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: