MEDICARE: JENNIFER L SCHAEFF PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601003865	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0755014260	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1558368886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L SCHAEFF PA-C

Provider Business Mailing Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 105
City	:	STERLING HTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-979-1750
Fax Number	:	586-979-4667

Provider Business Practice Location Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 105
City	:	STERLING HTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-979-1750
Fax Number	:	586-979-4667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	06/27/2008

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