Provider Demographics
NPI:1487653937
Name:SCHNEEKLOTH, DONALD J (DPM)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:SCHNEEKLOTH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 WINNECONNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3177
Mailing Address - Country:US
Mailing Address - Phone:920-722-0842
Mailing Address - Fax:920-722-6174
Practice Address - Street 1:797 WINNECONNE AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3177
Practice Address - Country:US
Practice Address - Phone:920-722-0842
Practice Address - Fax:920-722-6174
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI551213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391556068OtherTAX ID #
WI43211200Medicaid
WI391556068012OtherBCBS BILLING NUMBER
WI391556068OtherTAX ID #
WI000085215Medicare ID - Type UnspecifiedMEDICARE #
WI43211200Medicaid
WI480009371Medicare PIN