Healthcare Provider Details

I. General information

NPI: 1144570870
Provider Name (Legal Business Name): KENNETH L. SCHAUFELBERGER, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E ENTERPRISE AVE
APPLETON WI
54913-7862
US

IV. Provider business mailing address

2105 E ENTERPRISE AVE
APPLETON WI
54913-7862
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-3311
  • Fax: 920-731-7133
Mailing address:
  • Phone: 920-731-3311
  • Fax: 920-731-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH L. SCHAUFELBERGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 920-731-3311