Healthcare Provider Details

I. General information

NPI: 1205101664
Provider Name (Legal Business Name): SHAWN E SCHOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWN E WERNER MD

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066
US

IV. Provider business mailing address

36500 AURORA DR
SUMMIT WI
53066-4899
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-1000
  • Fax: 262-434-5889
Mailing address:
  • Phone: 262-434-1000
  • Fax: 262-434-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number69161
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301111582
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number69161
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: