Healthcare Provider Details

I. General information

NPI: 1366883522
Provider Name (Legal Business Name): ELIZABETH ERIN SCHUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ
FLINT MI
48503-5902
US

IV. Provider business mailing address

610 E MAIN ST APT D
FLUSHING MI
48433-2047
US

V. Phone/Fax

Practice location:
  • Phone: 616-901-8451
  • Fax:
Mailing address:
  • Phone: 616-901-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301102909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: