Provider Demographics
NPI:1972724839
Name:MEDICINE ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:MEDICINE ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHAUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:262-797-8600
Mailing Address - Street 1:PO BOX 510774
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-0774
Mailing Address - Country:US
Mailing Address - Phone:262-797-8600
Mailing Address - Fax:262-797-9122
Practice Address - Street 1:13700 W NATIONAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9521
Practice Address - Country:US
Practice Address - Phone:262-797-8600
Practice Address - Fax:262-797-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24397207R00000X
WI24253207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30017400Medicaid
WI30016900Medicaid
WI80099Medicare ID - Type Unspecified
WI30017400Medicaid
WI80208Medicare ID - Type Unspecified
WIB54440Medicare UPIN