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General NPI Number Information
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NPI Number | 1174083943
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Entity Type | Individual
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Provider Name | MARK D SCHAMBER CAA
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Gender | Male
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 11141 PARKVIEW PLAZA DR STE 200
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City | FORT WAYNE
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State | IN
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Zip | 46845-1714
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Country | US
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Telephone | 260-425-6030
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Fax | 260-425-6028
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Provider Business Mailing Address
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Address Line | 3333 EVERGREEN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9493
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 28513404
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 75000042A
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License Number State | IN
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