1093700288 NPI number — MR. GARY K SCHNELL MD

Table of content: MR. GARY K SCHNELL MD (NPI 1093700288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093700288 NPI number — MR. GARY K SCHNELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNELL
Provider First Name:
GARY
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093700288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N14W30125 HIGH RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53072-6112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-510-5988
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 W CAPITOL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-465-5770
Provider Business Practice Location Address Fax Number:
414-260-8980
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  26043-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30812600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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