Healthcare Provider Details

I. General information

NPI: 1881627602
Provider Name (Legal Business Name): DAVID SCHOENOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST
MANISTIQUE MI
49854-1522
US

IV. Provider business mailing address

500 MAIN ST
MANISTIQUE MI
49854-1522
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-3200
  • Fax: 906-341-2731
Mailing address:
  • Phone: 906-341-3200
  • Fax: 906-341-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301062130
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: