Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 11811 | SD |
N | 2086S0129X | Vascular Surgeon | 48131 | MA |
NPI | 1164528600 |
---|---|
Provider Name | Dr. Michael Gerard Schiedler |
First Address | Brockton, MA 02302-3308 |
Second Address | Lake Oswego, OR 97034-1656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 01/11/2021 |