Provider Demographics
NPI:1790992170
Name:ANDREW J. SCHROETTNER, MDSC
Entity Type:Organization
Organization Name:ANDREW J. SCHROETTNER, MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHROETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-567-1122
Mailing Address - Street 1:888 THACKERAY TRL
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4342
Mailing Address - Country:US
Mailing Address - Phone:262-567-1122
Mailing Address - Fax:262-567-1481
Practice Address - Street 1:888 THACKERAY TRL
Practice Address - Street 2:SUITE 211
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-567-1122
Practice Address - Fax:262-567-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI345682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31941000Medicaid
WI31941000Medicaid
WIF60097Medicare UPIN