Individual
SAMUEL RANDOLPH SCHEEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4003 KRESGE WAY, SUITE 226, LOUISVILLE, KY 40207-4652
(502) 893-1645
(502) 897-2338
Mailing address
4003 KRESGE WAY, SUITE 226, LOUISVILLE, KY 40207-4652
(502) 893-1645
(502) 897-2338
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21343
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000358728
ANTHEM
—
01
—
P00204656
RAIL ROAD MEDICARE
—
Enumeration date
09/07/2006
Last updated
07/08/2007
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