Provider Demographics
NPI:1043245459
Name:SCHROETTNER, ANDREW JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:SCHROETTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 THACKERAY TRAIL
Mailing Address - Street 2:#211
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4641
Mailing Address - Country:US
Mailing Address - Phone:262-567-1122
Mailing Address - Fax:262-567-1481
Practice Address - Street 1:888 THACKERAY TRAIL
Practice Address - Street 2:#211
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4641
Practice Address - Country:US
Practice Address - Phone:262-567-1122
Practice Address - Fax:262-567-1481
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI345682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31941000Medicaid
WI68096Medicare ID - Type Unspecified
WI31941000Medicaid