Provider Demographics
NPI:1013555945
Name:SCHNEIDER, BERTRAM M (CAC)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:M
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 JAECKLES DR
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-8900
Mailing Address - Country:US
Mailing Address - Phone:262-370-4451
Mailing Address - Fax:
Practice Address - Street 1:23 S MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1867
Practice Address - Country:US
Practice Address - Phone:262-674-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI571-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist