Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 42344 | WI |
Y | 207Q00000X | Family Doctor | 42344-21 | WI |
NPI | 1407951130 |
---|---|
Provider Name | Dr. Scott Robert Schinschke |
First Address | Green Bay, WI 54307-9070 |
Second Address | Pulaski, WI 54162-9453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 17/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203932743 | TAX ID (01) | WI |
H36656 | (02) | WI |