Basic Information
| Provider Information | |||||||||
| NPI: | 1649314832 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SCHROEDERUS | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 788 N JEFFERSON ST | ||||||||
| Address2: | SUITE 300/ATTN, KAAREN BUTZEN | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532023718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142728950 | ||||||||
| FaxNumber: | 4142720859 | ||||||||
| Practice Location | |||||||||
| Address1: | 13133 N PORT WASHINGTON RD | ||||||||
| Address2: | SUITE G-18 | ||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530972419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622435000 | ||||||||
| FaxNumber: | 2622435317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 55114 | WI | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 2080P0201X | 55114 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
ID Information
| ID | Type | State | Issuer | Description | 1649314832 | 05 | WI | MEDICAID |