1437135431 NPI number — PAULA KAY SCHRECK MD

Table of content: PAULA KAY SCHRECK MD (NPI 1437135431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437135431 NPI number — PAULA KAY SCHRECK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRECK
Provider First Name:
PAULA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1437135431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22101 MOROSS RD
Provider Second Line Business Mailing Address:
5 WEST
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-2148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-343-3146
Provider Business Mailing Address Fax Number:
313-417-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46591 ROMEO PLANK RD
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
MACOMB TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48044-5742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-226-6250
Provider Business Practice Location Address Fax Number:
586-226-6255
Provider Enumeration Date:
12/21/2005

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: 208000000X , with the licence number:  4301070703 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4172308 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0E011720 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0Q262160 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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