Provider Demographics
NPI:1902889439
Name:SCHLOTTERER, WILLIAM L (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:SCHLOTTERER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 CLEVELAND RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4374
Mailing Address - Country:US
Mailing Address - Phone:419-625-7122
Mailing Address - Fax:419-625-8149
Practice Address - Street 1:1610 CLEVELAND RD
Practice Address - Street 2:STE. 103
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4374
Practice Address - Country:US
Practice Address - Phone:419-625-7122
Practice Address - Fax:419-625-8149
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130558OtherANTHEM BLUE CROSS
OH0468319Medicaid
4090204OtherAETNA
P03259OtherHEALTHSCOPE
P03259OtherHEALTHSCOPE
C02116Medicare UPIN
SC0498101Medicare ID - Type Unspecified