Healthcare Provider Details

I. General information

NPI: 1063754810
Provider Name (Legal Business Name): EMILY THERESE SCHROEDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY THERESE CARBOTT PA

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

IV. Provider business mailing address

750 STEPHENSON HWY BEAUMONT PAYOR CONTRACT SERVICES
TROY MI
48083-1103
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-5000
  • Fax:
Mailing address:
  • Phone: 248-577-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006623
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: