MEDICARE: DR. EDUARDO SCHOLCOFF MD

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	207Q00000X	Family Medicine Physician	036092014	IL
2	207Q00000X	Family Medicine Physician	55192	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	036092014	OTHER	IL	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669457214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO SCHOLCOFF MD

Provider Business Mailing Address
First Line	:	10000 W INNOVATION DR
Second Line	:	SUITE 300
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4837
Country	:	US
Telephone Number	:	414-456-5006
Fax Number	:	414-456-6259

Provider Business Practice Location Address
First Line	:	210 NW BARSTOW ST
Second Line	:	SUITE 201
City	:	WAUKESHA
State	:	WI
Zip	:	53188-3771
Country	:	US
Telephone Number	:	262-548-6903
Fax Number	:	262-548-3820

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/28/2011

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Directions to “ DR. EDUARDO SCHOLCOFF MD” Practice Location

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