Provider Demographics
NPI:1356348122
Name:SCHERER, JACK R (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:R
Last Name:SCHERER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:955 N MICHIGAN AVE STE 81
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1487
Practice Address - Country:US
Practice Address - Phone:812-222-0202
Practice Address - Fax:812-222-0204
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023422207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
051590Medicare ID - Type Unspecified
D94421Medicare UPIN
IN132590KKMedicare PIN