Provider Demographics
NPI:1649381849
Name:VAN SCHAIK, JAN C (MD)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:C
Last Name:VAN SCHAIK
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 1:5570 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5218
Mailing Address - Country:US
Mailing Address - Phone:414-961-0200
Mailing Address - Fax:414-961-0400
Practice Address - Street 1:5570 N LAKE DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5218
Practice Address - Country:US
Practice Address - Phone:414-961-0200
Practice Address - Fax:414-961-0400
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232810202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B57285Medicare UPIN
WI01323Medicare ID - Type Unspecified