Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 55114 | WI |
N | 2080P0201X | Pediatric Allergist | 55114 | WI |
NPI | 1649314832 |
---|---|
Provider Name | Kristin M Schroederus |
First Address | Milwaukee, WI 53202-3718 |
Second Address | Mequon, WI 53097-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1649314832 | (05) | WI |