Provider Demographics
NPI:1447211958
Name:SCHNELL, BRIAN M
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:SCHNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1620 MEDICAL LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1143
Practice Address - Country:US
Practice Address - Phone:239-275-1164
Practice Address - Fax:610-271-4245
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71896207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002141000Medicaid
TN4118676OtherBLUE CROSS TN
FLP944518OtherOPTIMUM
FL4605457OtherCIGNA
FL7079891OtherAETNA
FLP01051887OtherRAILROAD MCR
FLP118391OtherFREEDOM HEALTH
FL32608OtherBCBS
FL7079891OtherAETNA
FLF20832Medicare UPIN
FLDC745ZMedicare Oscar/Certification
FL32608OtherBCBS
FLDC745YMedicare PIN
FLP118391OtherFREEDOM HEALTH