Provider Demographics
NPI:1235391194
Name:SCHROEDER, ABIGAIL B (PA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:B
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5700
Mailing Address - Fax:414-259-9225
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5700
Practice Address - Fax:414-259-9225
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006155RX363A00000X
WI2275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42004200Medicaid
WI1235391194Medicaid