Provider Demographics
NPI:1629052428
Name:SCHAEFER, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8901 W LINCOLN AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2409
Mailing Address - Country:US
Mailing Address - Phone:414-329-4300
Mailing Address - Fax:
Practice Address - Street 1:8901 W LINCOLN AVE
Practice Address - Street 2:2ND FL
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2409
Practice Address - Country:US
Practice Address - Phone:414-329-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI31911-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1629052428Medicaid
WI1629052428Medicaid
WI0009-73510Medicare ID - Type UnspecifiedPROVIDER NUMBER