Healthcare Provider Details

I. General information

NPI: 1629094214
Provider Name (Legal Business Name): EAR NOSE & THROAT SURGICAL ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N MEADE ST
APPLETON WI
54911-3762
US

IV. Provider business mailing address

1520 N MEADE ST
APPLETON WI
54911-3762
US

V. Phone/Fax

Practice location:
  • Phone: 920-734-7181
  • Fax: 920-734-0621
Mailing address:
  • Phone: 920-734-7181
  • Fax: 920-734-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KENT C SCHAEFER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 920-734-7181