Provider Demographics
NPI:1780878454
Name:DR. DONALD J. SCHNEEKLOTH, D.P.M.
Entity type:Organization
Organization Name:DR. DONALD J. SCHNEEKLOTH, D.P.M.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNEEKLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:920-722-0842
Mailing Address - Street 1:797 WINNECONNE AVE.
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956
Mailing Address - Country:US
Mailing Address - Phone:920-722-0842
Mailing Address - Fax:920-722-6174
Practice Address - Street 1:797 WINNECONNE AVE.
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956
Practice Address - Country:US
Practice Address - Phone:920-722-0842
Practice Address - Fax:920-722-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI551213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43211200Medicaid
WI43211200Medicaid
WI=========012OtherBCBS
WI480009371Medicare PIN
WI43211200Medicaid
WI000085215Medicare PIN