Provider Demographics
NPI:1215029145
Name:SCHAEFER, WENDELIN WALTER (M D)
Entity Type:Individual
Prefix:
First Name:WENDELIN
Middle Name:WALTER
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 FAIRWAY VIEW COURT
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451
Mailing Address - Country:US
Mailing Address - Phone:775-833-2145
Mailing Address - Fax:
Practice Address - Street 1:978 FAIRWAY VIEW COURT
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451
Practice Address - Country:US
Practice Address - Phone:775-833-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18918-020174400000X
CAG14516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE09584Medicare UPIN