1699773887 NPI number — LEA ANN SCHROETER MD

Table of content: LEA ANN SCHROETER MD (NPI 1699773887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699773887 NPI number — LEA ANN SCHROETER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROETER
Provider First Name:
LEA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHROETER
Provider Other First Name:
LEAANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699773887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N10565 GRANDVIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONWOOD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49938-9622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-932-1500
Provider Business Mailing Address Fax Number:
906-932-5630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 GRANITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURLEY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54534-1384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-561-2255
Provider Business Practice Location Address Fax Number:
715-561-5021
Provider Enumeration Date:
07/12/2005

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: 208000000X , with the licence number:  4301050609 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 26178 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4307534 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: LS050609 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1018466 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12D82SC . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30735100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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