Provider Demographics
NPI:1164457479
Name:SCHELLPFEFFER, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SCHELLPFEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 76TH STREET
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1984
Mailing Address - Country:US
Mailing Address - Phone:262-577-8080
Mailing Address - Fax:262-577-8081
Practice Address - Street 1:9555 76TH STREET
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1984
Practice Address - Country:US
Practice Address - Phone:262-577-8080
Practice Address - Fax:262-577-8081
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25699020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3411471180002OtherCIGNA
WI39114711853143OtherTRICARE
WI30599600Medicaid
16410535932OtherHUMANA
WI7102000W15143OtherMICHIGAN BC
WI0004016521OtherAETNA
WI0004016521OtherAETNA
WI32082Medicare ID - Type Unspecified