MEDICARE: DR. KENNETH G SCHELLHASE 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	43093	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005006261T	OTHER		HUMANA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982655452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH G SCHELLHASE MD

Provider Business Mailing Address
First Line	:	210 NW BARSTOW ST
Second Line	:	WAUKESHA FAMILY PRACTICE CENTER
City	:	WAUKESHA
State	:	WI
Zip	:	53188-3771
Country	:	US
Telephone Number	:	262-548-6907
Fax Number	:	262-548-3820

Provider Business Practice Location Address
First Line	:	210 NW BARSTOW ST
Second Line	:	WAUKESHA FAMILY PRACTICE CENTER
City	:	WAUKESHA
State	:	WI
Zip	:	53188-3771
Country	:	US
Telephone Number	:	262-548-6907
Fax Number	:	262-548-3820

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/09/2013

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