Healthcare Provider Details

I. General information

NPI: 1255429007
Provider Name (Legal Business Name): GERIATRIC AND MEDICAL SPECIALISTS OF MICHIGAN P L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ROBERT T LONGWAY BLVD STE #A
FLINT MI
48503-2190
US

IV. Provider business mailing address

5155 NORKO DRIVE
FLINT MI
48507-3021
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-6700
  • Fax: 810-743-1610
Mailing address:
  • Phone: 810-720-6700
  • Fax: 810-743-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801035828
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301405199
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDOLPH E. SCHUMACHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 810-235-2599