Healthcare Provider Details

I. General information

NPI: 1225452832
Provider Name (Legal Business Name): MICHAEL J SCHETTER DMSC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 SPRING VALLEY DR STE 110
HOLLAND OH
43528-9374
US

IV. Provider business mailing address

105 LAVENDER HILL DR
ETNA OH
43062-7370
US

V. Phone/Fax

Practice location:
  • Phone: 855-659-7734
  • Fax:
Mailing address:
  • Phone: 937-360-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003996RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: