Provider Demographics
NPI:1447050851
Name:SCHROEDER, BRADLEY IAN
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:IAN
Last Name:SCHROEDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 W 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9760
Mailing Address - Country:US
Mailing Address - Phone:219-669-6623
Mailing Address - Fax:
Practice Address - Street 1:6541 W 205TH AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-9760
Practice Address - Country:US
Practice Address - Phone:219-669-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program