Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 17696 | KY |
NPI | 1245297530 |
---|---|
Provider Name | Dr. Martin G Schiller |
First Address | Louisville, KY 40205-1331 |
Second Address | Louisville, KY 40217-1319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000062722 | ANTHEM BCBS (01) | KY |
1052537 | PASSPORT HEALTH PLANS (01) | KY |
64176969 | (05) | KY |
C72234 | (02) | KY |