1962584615 NPI number — DR. LOIS SCHAFER PHD

Table of content: DR. LOIS SCHAFER PHD (NPI 1962584615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962584615 NPI number — DR. LOIS SCHAFER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFER
Provider First Name:
LOIS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962584615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42627 GARFIELD RD
Provider Second Line Business Mailing Address:
SUITE 216-C
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-246-5164
Provider Business Mailing Address Fax Number:
844-621-4391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42627 GARFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 216-C
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-246-5164
Provider Business Practice Location Address Fax Number:
844-621-4391
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301008020 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301008020 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 6301008020 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 143624 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P111686 . This is a "BLUE CROSS NETWORK OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11409 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 680E04600 . This is a "BLUE CROSS BLUE SHEILD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G2157173 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".