Healthcare Provider Details

I. General information

NPI: 1164528600
Provider Name (Legal Business Name): MICHAEL GERARD SCHIEDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 BONNIEBRAE DR
LAKE OSWEGO OR
97034-1656
US

IV. Provider business mailing address

680 CENTRE ST
BROCKTON MA
02302-3308
US

V. Phone/Fax

Practice location:
  • Phone: 503-756-1554
  • Fax:
Mailing address:
  • Phone: 508-941-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00038618
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD14949
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number11811
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number48131
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: