MEDICARE: DR. RICHARD M SCHAEFER M.D.

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	208D00000X	General Practice Physician	26037-20	WI

General Provider Information

NPI Number	:	1396729109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD M SCHAEFER M.D.

Provider Business Mailing Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 240
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1599
Country	:	US
Telephone Number	:	414-988-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 240
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1599
Country	:	US
Telephone Number	:	414-988-6350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/05/2011

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