1407154313 NPI number — MR. STACEY SCHUERMAN LAT

Table of content: MR. STACEY SCHUERMAN LAT (NPI 1407154313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407154313 NPI number — MR. STACEY SCHUERMAN LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUERMAN
Provider First Name:
STACEY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LAT
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:
1407154313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2426 SPRINGDALE RD
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-630-4049
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 DELAFIELD ST
Provider Second Line Business Practice Location Address:
120
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-544-5311
Provider Business Practice Location Address Fax Number:
262-521-1091
Provider Enumeration Date:
03/02/2011

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: 2255A2300X , with the licence number:  1230-039 , 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)





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