Provider Demographics
NPI:1982655452
Name:SCHELLHASE, KENNETH G (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:SCHELLHASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:WAUKESHA FAMILY PRACTICE CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-548-6907
Mailing Address - Fax:262-548-3820
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:WAUKESHA FAMILY PRACTICE CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-548-6907
Practice Address - Fax:262-548-3820
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI43093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
005006261TOtherHUMANA
WI1982655452Medicaid
WI1982655452Medicaid
WI020968086Medicare PIN
WI73601 2520Medicare PIN