1699878256 NPI number — DR. KEVIN MAKAY SCHUMACHER PHD

Table of content: DR. KEVIN MAKAY SCHUMACHER PHD (NPI 1699878256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699878256 NPI number — DR. KEVIN MAKAY SCHUMACHER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUMACHER
Provider First Name:
KEVIN
Provider Middle Name:
MAKAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

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:
1699878256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3137 32ND AVE S
Provider Second Line Business Mailing Address:
SUITE 223
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103-6159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-365-4488
Provider Business Mailing Address Fax Number:
701-365-0727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 25TH ST S STE Z
Provider Second Line Business Practice Location Address:
#340
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-365-4488
Provider Business Practice Location Address Fax Number:
701-365-0727
Provider Enumeration Date:
09/07/2006

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: 103TC0700X , with the licence number:  111 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16951 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909550100 . This is a "MEDICAID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".