Healthcare Provider Details

I. General information

NPI: 1184922478
Provider Name (Legal Business Name): SCHAEFER MEDICAL SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S 76TH ST SUITE 240
MILWAUKEE WI
53214-1599
US

IV. Provider business mailing address

620 S 76TH ST SUITE 240
MILWAUKEE WI
53214-1599
US

V. Phone/Fax

Practice location:
  • Phone: 414-988-6350
  • Fax: 414-988-6355
Mailing address:
  • Phone: 414-988-6350
  • Fax: 414-988-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD M. SCHAEFER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-573-1300