Healthcare Provider Details

I. General information

NPI: 1629053806
Provider Name (Legal Business Name): DOV SCHUCHMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43700 WOODWARD AVE SUITE 114
BLOOMFIELD HILLS MI
48302-5058
US

IV. Provider business mailing address

PO BOX 77000 DEPT 77446
DETROIT MI
48277-2000
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-4211
  • Fax: 248-332-9377
Mailing address:
  • Phone: 248-334-4211
  • Fax: 248-332-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOV SCHUCHMAN
Title or Position: MANAGING AGENT
Credential: MD
Phone: 248-334-4211