Healthcare Provider Details

I. General information

NPI: 1871566489
Provider Name (Legal Business Name): GARY J SCHAUB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 US 31 NORTH
WILLIAMSBURG MI
49690
US

IV. Provider business mailing address

PO BOX 515
ACME MI
49610-0515
US

V. Phone/Fax

Practice location:
  • Phone: 231-938-5983
  • Fax:
Mailing address:
  • Phone: 231-938-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: