Healthcare Provider Details

I. General information

NPI: 1588695738
Provider Name (Legal Business Name): MARK A SCHRAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N PORT WASHINGTON RD
GLENDALE WI
53217-3838
US

IV. Provider business mailing address

7080 N PORT WASHINGTON RD
GLENDALE WI
53217-3838
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-4009
  • Fax: 414-351-7060
Mailing address:
  • Phone: 414-351-4009
  • Fax: 414-351-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number17692
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: