Provider Demographics
NPI:1932337912
Name:SCHRADER, RYAN M (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2323 N MAYFAIR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1506
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-727-1058
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9417
Practice Address - Country:US
Practice Address - Phone:414-384-6700
Practice Address - Fax:414-761-1921
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2012-11-30
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Provider Licenses
StateLicense IDTaxonomies
WI2451-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932337912Medicaid
WI1932337912Medicaid