Healthcare Provider Details

I. General information

NPI: 1699773887
Provider Name (Legal Business Name): LEA ANN SCHROETER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAANN SCHROETER MD

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GRANITE ST
HURLEY WI
54534-1384
US

IV. Provider business mailing address

N10565 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-2255
  • Fax: 715-561-5021
Mailing address:
  • Phone: 906-932-1500
  • Fax: 906-932-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301050609
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26178
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: