MEDICARE: JANICE SCHARICH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	5501005818	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650D116170	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1588601769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE SCHARICH

Provider Business Mailing Address
First Line	:	118 IVANHOE AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-1329
Country	:	US
Telephone Number	:	616-450-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 MEDICAL PARK DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3686
Country	:	US
Telephone Number	:	616-949-7310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/15/2018

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Directions to “ JANICE SCHARICH ” Practice Location

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