Healthcare Provider Details

I. General information

NPI: 1689667909
Provider Name (Legal Business Name): MICHAEL R SCHUSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S COLUMBIA RD
GRAND FORKS ND
58201-4012
US

IV. Provider business mailing address

PO BOX 6002
GRAND FORKS ND
58206-6002
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax: 701-780-1942
Mailing address:
  • Phone: 701-780-5000
  • Fax: 701-780-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10338
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10338
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: