Basic Information
| Provider Information | |||||||||
| NPI: | 1265487201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULGIT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W GLEN OAKS LN STE 105 | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530923369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144348524 | ||||||||
| FaxNumber: | 4143652937 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W KINNICKINNICK RIVER PARKWAY | ||||||||
| Address2: | 105 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146493610 | ||||||||
| FaxNumber: | 4146495217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 24616 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 30823400 | 05 | WI | MEDICAID |