Healthcare Provider Details

I. General information

NPI: 1235417486
Provider Name (Legal Business Name): INTEGRATED PAIN AND HEALTH CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 N PORT WASHINGTON RD SUITE 101
GLENDALE WI
53217-4903
US

IV. Provider business mailing address

5261 N PORT WASHINGTON RD SUITE 101
GLENDALE WI
53217-4903
US

V. Phone/Fax

Practice location:
  • Phone: 414-332-6001
  • Fax: 414-332-3712
Mailing address:
  • Phone: 414-332-6001
  • Fax: 414-332-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number48739
License Number StateWI

VIII. Authorized Official

Name: DR. COREY SCHNEIDER
Title or Position: PRESIDENT
Credential:
Phone: 414-332-6001