MEDICARE: INTEGRATED PAIN AND HEALTH CENTER, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	48739	WI

General Provider Information

NPI Number	:	1235417486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED PAIN AND HEALTH CENTER, SC

Provider Business Mailing Address
First Line	:	5261 N PORT WASHINGTON RD
Second Line	:	SUITE 101
City	:	GLENDALE
State	:	WI
Zip	:	53217-4903
Country	:	US
Telephone Number	:	414-332-6001
Fax Number	:	414-332-3712

Provider Business Practice Location Address
First Line	:	5261 N PORT WASHINGTON RD
Second Line	:	SUITE 101
City	:	GLENDALE
State	:	WI
Zip	:	53217-4903
Country	:	US
Telephone Number	:	414-332-6001
Fax Number	:	414-332-3712

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. COREY SCHNEIDER
Credential	:
Telephone Number	:	414-332-6001

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	07/21/2011

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