Healthcare Provider Details

I. General information

NPI: 1437135431
Provider Name (Legal Business Name): PAULA KAY SCHRECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46591 ROMEO PLANK RD 205
MACOMB TWP MI
48044-5742
US

IV. Provider business mailing address

22101 MOROSS RD 5 WEST
DETROIT MI
48236-2148
US

V. Phone/Fax

Practice location:
  • Phone: 586-226-6250
  • Fax: 586-226-6255
Mailing address:
  • Phone: 313-343-3146
  • Fax: 313-417-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301070703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: