Provider Demographics
NPI:1538109772
Name:SCHNEIDER, GEORGE R (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:SCHNEIDER
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 1:705 S UNIVERSITY AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3081
Mailing Address - Country:US
Mailing Address - Phone:920-887-3102
Mailing Address - Fax:920-885-8788
Practice Address - Street 1:705 S UNIVERSITY AVE STE 510
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3081
Practice Address - Country:US
Practice Address - Phone:920-887-3102
Practice Address - Fax:920-885-8788
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31210900Medicaid
WI61114OtherDEAN HEALTH PLAN
WI61114OtherDEAN HEALTH PLAN