Provider Demographics
NPI:1518953249
Name:SCHROEDER, GEORGE S (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:SCHROEDER
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 1:1000 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-1921
Mailing Address - Country:US
Mailing Address - Phone:920-893-0526
Mailing Address - Fax:920-893-9409
Practice Address - Street 1:1000 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-1921
Practice Address - Country:US
Practice Address - Phone:920-893-0526
Practice Address - Fax:920-893-9409
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23231020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30346400Medicaid
WI000060110Medicare PIN
WI30346400Medicaid