Healthcare Provider Details

I. General information

NPI: 1669538310
Provider Name (Legal Business Name): JAN C VAN SCHAIK MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 N LAKE DRIVE 0
WHITEFISH BAY WI
53217-5218
US

IV. Provider business mailing address

5570 N LAKE DRIVE 0
WHITEFISH BAY WI
53217-5218
US

V. Phone/Fax

Practice location:
  • Phone: 414-961-0200
  • Fax: 414-961-0400
Mailing address:
  • Phone: 414-961-0200
  • Fax: 414-961-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23281020
License Number StateWI

VIII. Authorized Official

Name: DR. JAN C VAN SCHAIK
Title or Position: PRESIDENT JAN C VAN SCHAIK MD SC
Credential: MD
Phone: 414-961-0200