1821366535 NPI number — PETER E SCHAFFER DPM

Table of content: MARIE ANNE SOSA M.D. (NPI 1710193032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821366535 NPI number — PETER E SCHAFFER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER E SCHAFFER DPM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1821366535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 N OLD WOODWARD AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-594-3338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N OLD WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-594-3338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAFFER
Authorized Official First Name:
PETER
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
248-594-3338

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5901000620 , 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: 4650420001 . This is a "MEDICARE SUPPLIER PIN NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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