Healthcare Provider Details

I. General information

NPI: 1881180933
Provider Name (Legal Business Name): PAUL MICHAEL SCHROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 HURON AVE STE B
PORT HURON MI
48060-3869
US

IV. Provider business mailing address

309 HURON AVE STE B
PORT HURON MI
48060-3869
US

V. Phone/Fax

Practice location:
  • Phone: 810-689-9899
  • Fax: 810-662-0255
Mailing address:
  • Phone: 810-689-9899
  • Fax: 810-662-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801063647
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: