Provider Demographics
NPI:1821055583
Name:SCHNEE, BRADLEY K (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:K
Last Name:SCHNEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2825 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-3429
Mailing Address - Country:US
Mailing Address - Phone:608-742-7161
Mailing Address - Fax:608-745-3990
Practice Address - Street 1:2825 HUNTERS TRL
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3429
Practice Address - Country:US
Practice Address - Phone:608-742-7161
Practice Address - Fax:608-745-3990
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37924-020207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821055583Medicaid
WI1821055583Medicaid
WIK400180996Medicare PIN
WI132150119Medicare PIN
CO264189163OtherCHAMPUS WEST REGION
WI5309OtherDEAN HEALTH PLAN
WI32262300Medicaid
CO18210055593OtherROCKY MOUNTAIN HMO