Healthcare Provider Details

I. General information

NPI: 1568686509
Provider Name (Legal Business Name): RALPH JAMES SCHILLACE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD SUITE 101
ROCHESTER HILLS MI
48309-1753
US

IV. Provider business mailing address

1796 KILBURN RD N
ROCHESTER HILLS MI
48306-3034
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-1303
  • Fax: 248-652-3620
Mailing address:
  • Phone: 586-805-5329
  • Fax: 248-652-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number6301001724
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301001724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: