Healthcare Provider Details

I. General information

NPI: 1972035012
Provider Name (Legal Business Name): JEFFREY D SCHAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEAGATE #800
TOLEDO OH
43604-1558
US

IV. Provider business mailing address

2109 HUGHES DR #220
TOLEDO OH
43606-3856
US

V. Phone/Fax

Practice location:
  • Phone: 567-585-1983
  • Fax: 419-824-7359
Mailing address:
  • Phone: 419-291-5150
  • Fax: 419-479-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.020739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: