Healthcare Provider Details

I. General information

NPI: 1275706699
Provider Name (Legal Business Name): PEGGY SCHAEFER H.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4038 E TOWNE BLVD
MADISON WI
53704-3734
US

IV. Provider business mailing address

140 CORPORATE DR SUITE 1
BEAVER DAM WI
53916-1281
US

V. Phone/Fax

Practice location:
  • Phone: 608-240-2900
  • Fax: 920-887-9655
Mailing address:
  • Phone:
  • Fax: 920-887-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number608-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: