Provider Demographics
NPI:1699773887
Name:SCHROETER, LEA ANN (MD)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ANN
Last Name:SCHROETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEAANN
Other - Middle Name:
Other - Last Name:SCHROETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:906-932-5630
Practice Address - Street 1:501 GRANITE ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1384
Practice Address - Country:US
Practice Address - Phone:715-561-2255
Practice Address - Fax:715-561-5021
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050609208000000X
WI26178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4307534Medicaid
MILS050609OtherBLUE CROSS BLUE SHIELD MI
1018466OtherPREFERREDONE
MN12D82SCOtherBCBS
WI30735100Medicaid
MN12D82SCOtherBCBS
1018466OtherPREFERREDONE
010056907Medicare PIN
WI0004Medicare PIN