1578625794 NPI number — MICHAEL A SCHELLPFEFFER MD OB GYN SC

Table of content: (NPI 1578625794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578625794 NPI number — MICHAEL A SCHELLPFEFFER MD OB GYN SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL A SCHELLPFEFFER MD OB GYN SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578625794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 75TH ST
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-658-2133
Provider Business Mailing Address Fax Number:
262-658-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 75TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-658-2133
Provider Business Practice Location Address Fax Number:
262-658-2699
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHELLPFEFFER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
262-658-2133

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25699020 , 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: 398443880006 . This is a "BC COMPCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0004016521 . This is a "AETNA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 30599600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164210535932 . This is a "HUMANA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 71G2000W15143 . This is a "MICHIGAN BC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 3411471180002 . This is a "CIGNA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com