Provider Demographics
NPI:1669538310
Name:JAN C VAN SCHAIK MD SC
Entity type:Organization
Organization Name:JAN C VAN SCHAIK MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT JAN C VAN SCHAIK MD SC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAN SCHAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-961-0200
Mailing Address - Street 1:5570 N LAKE DRIVE
Mailing Address - Street 2:0
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5218
Mailing Address - Country:US
Mailing Address - Phone:414-961-0200
Mailing Address - Fax:414-961-0400
Practice Address - Street 1:5570 N LAKE DRIVE
Practice Address - Street 2:0
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5218
Practice Address - Country:US
Practice Address - Phone:414-961-0200
Practice Address - Fax:414-961-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232810202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B57285Medicare UPIN
WI01323Medicare ID - Type Unspecified