Healthcare Provider Details

I. General information

NPI: 1053475764
Provider Name (Legal Business Name): MICHAEL J SCHNEIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

IV. Provider business mailing address

403 STAGELINE RD
HUDSON WI
54016-7848
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8000
  • Fax: 715-268-0311
Mailing address:
  • Phone: 715-531-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48035
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48035
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number62940
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: