Provider Demographics
NPI:1053019893
Name:CARUSO-SCHAEFER, NICHOLAS ALLEN BINDER (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALLEN BINDER
Last Name:CARUSO-SCHAEFER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:ALLEN BINDER
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-7040
Mailing Address - Fax:414-955-0175
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-7040
Practice Address - Fax:414-955-0175
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100242577Medicaid