=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972724839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICINE ASSOCIATES, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 05/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13700 W NATIONAL AVE SUITE 207
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-9521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-797-8600
-----------------------------------------------------
Fax | 262-797-9122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 510774
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-0774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-797-8600
-----------------------------------------------------
Fax | 262-797-9122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. FREDERICK L SCHAUMBERG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 262-797-8600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 24253
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 24397
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------