Provider Demographics
NPI:1578625794
Name:MICHAEL A SCHELLPFEFFER MD OB GYN SC
Entity Type:Organization
Organization Name:MICHAEL A SCHELLPFEFFER MD OB GYN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHELLPFEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-658-2133
Mailing Address - Street 1:1400 75TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143
Mailing Address - Country:US
Mailing Address - Phone:262-658-2133
Mailing Address - Fax:262-658-2699
Practice Address - Street 1:1400 75TH STREET
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143
Practice Address - Country:US
Practice Address - Phone:262-658-2133
Practice Address - Fax:262-658-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25699020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI398443880006OtherBC COMPCARE
WI0004016521OtherAETNA
WI30599600Medicaid
WI164210535932OtherHUMANA
WI71G2000W15143OtherMICHIGAN BC
WI3411471180002OtherCIGNA
WI398443880006OtherBC COMPCARE
WI0004016521OtherAETNA
WI71G2000W15143OtherMICHIGAN BC