Provider Demographics
NPI:1134285182
Name:SHEBOYGAN PEDIATRIC ASSOCIATES SC
Entity Type:Organization
Organization Name:SHEBOYGAN PEDIATRIC ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-458-3331
Mailing Address - Street 1:2920 SUPERIOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-458-3331
Mailing Address - Fax:920-458-1387
Practice Address - Street 1:2920 SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-458-3331
Practice Address - Fax:920-458-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty