=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205577780
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUINN MICHAEL SCHROEDER DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2022
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 CLINIC DR
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42431-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-825-7258
-----------------------------------------------------
Fax | 270-643-4271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CLINIC DR
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42431-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-825-7258
-----------------------------------------------------
Fax | 270-643-4271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 298810
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------