Provider Demographics
NPI:1508851403
Name:SCHLAIS, DALE L (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:SCHLAIS
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 1:1420 ALGOMA ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-2104
Mailing Address - Country:US
Mailing Address - Phone:920-982-8300
Mailing Address - Fax:
Practice Address - Street 1:1420 ALGOMA ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2104
Practice Address - Country:US
Practice Address - Phone:920-982-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31408200Medicaid
B85231Medicare UPIN
WI31408200Medicaid