Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 30796 | MN |
Y | 207X00000X | Orthopaedic Surgeon | 69663 | MN |
NPI | 1013537620 |
---|---|
Provider Name | Samuel Niles Schrader |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2020 |
Last Update Date | 27/08/2021 |