Provider Demographics
NPI:1902028889
Name:SCHOEPPACH, NATHAN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ROBERT
Last Name:SCHOEPPACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54847-4690
Mailing Address - Country:US
Mailing Address - Phone:715-372-5001
Mailing Address - Fax:715-372-5067
Practice Address - Street 1:7665 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:WI
Practice Address - Zip Code:54847-4690
Practice Address - Country:US
Practice Address - Phone:715-372-5001
Practice Address - Fax:715-372-5067
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49854207Q00000X
WI53607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN181975000Medicaid
P00438367OtherRR MEDICARE PTAN
MN0128314OtherMEDICA
MN35P57SCOtherBCBS
P00438367OtherRR MEDICARE PTAN