Healthcare Provider Details

I. General information

NPI: 1609412758
Provider Name (Legal Business Name): PETER ANDREW SCHAIBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date: 04/01/2026
Reactivation Date: 05/04/2026

III. Provider practice location address

22250 PROVIDENCE DR
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

22250 PROVIDENCE DR
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-7745
  • Fax: 248-569-4539
Mailing address:
  • Phone: 248-569-7745
  • Fax: 248-569-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number5151017792
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: