Provider Demographics
NPI:1194781641
Name:SCHAUMBERG, FREDERICK L (DO)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:SCHAUMBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 W NATIONAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9521
Mailing Address - Country:US
Mailing Address - Phone:262-797-8600
Mailing Address - Fax:262-797-9122
Practice Address - Street 1:13700 W NATIONAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9521
Practice Address - Country:US
Practice Address - Phone:262-797-8600
Practice Address - Fax:262-797-9122
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24253207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30016900Medicaid
WIB56332Medicare UPIN
WI80208Medicare ID - Type Unspecified