Provider Demographics
NPI:1730167164
Name:SCHEKORRA, FREDERICK MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:SCHEKORRA
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 1:901 KIDWELL
Mailing Address - Street 2:CAPITAL REGION MEDICAL CLINIC VERSAILLES
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084
Mailing Address - Country:US
Mailing Address - Phone:573-378-4666
Mailing Address - Fax:573-378-5099
Practice Address - Street 1:901 KIDWELL
Practice Address - Street 2:CAPITAL REGION MEDICAL CLINIC VERSAILLES
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084
Practice Address - Country:US
Practice Address - Phone:573-378-4666
Practice Address - Fax:573-378-5099
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J23207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8476OtherBLUE CROSS BLUE SHIELD
853020OtherFIRST HEALTH
MO500383609Medicaid
MO242714707Medicaid
440546366OtherUNITED HEALTHCARE
197480OtherHEALTHLINK
C78607OtherMERCY
STL0104039OtherUNITED HEALTHCARE
2213786OtherCIGNA
003012090Medicare ID - Type Unspecified
000012090Medicare ID - Type UnspecifiedGROUP NUMBER
2213786OtherCIGNA
197480OtherHEALTHLINK
CD6730Medicare ID - Type UnspecifiedRR