Provider Demographics
NPI:1598705154
Name:SCHOENFELDER, PATRICK G (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:SCHOENFELDER
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 1:1515 N 42ND AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1466
Mailing Address - Country:US
Mailing Address - Phone:218-525-0529
Mailing Address - Fax:
Practice Address - Street 1:4211 MINNKOTA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6078
Practice Address - Country:US
Practice Address - Phone:218-444-6127
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE57033Medicare UPIN