Healthcare Provider Details

I. General information

NPI: 1427443910
Provider Name (Legal Business Name): PAUL SCHRODER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 FISH HATCHERY RD APT 435
MADISON WI
53715-2231
US

IV. Provider business mailing address

1007 FISH HATCHERY RD APT 435
MADISON WI
53715-2231
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-1384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number77245
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number77245
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: