Provider Demographics
NPI:1962501346
Name:SCHROEDER, MICHELLE A (DPM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1011
Mailing Address - Country:US
Mailing Address - Phone:608-829-2535
Mailing Address - Fax:608-829-1319
Practice Address - Street 1:6661 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1011
Practice Address - Country:US
Practice Address - Phone:608-829-2535
Practice Address - Fax:608-829-1319
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI872213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43235400Medicaid
WI43235400Medicaid