Healthcare Provider Details

I. General information

NPI: 1295113249
Provider Name (Legal Business Name): CALLIE KORLISS SCHNITKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HOSPITAL RD
NEW RICHMOND WI
54017
US

IV. Provider business mailing address

1732 MINNEHAHA AVE W
SAINT PAUL MN
55104-1153
US

V. Phone/Fax

Practice location:
  • Phone: 715-243-2600
  • Fax:
Mailing address:
  • Phone: 651-214-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number63617
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number63617
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number69417
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: