MEDICARE: JONATHAN SCHAEFER

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1770006579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN SCHAEFER

Provider Business Mailing Address
First Line	:	9035 NW 51ST PL
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-1929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9035 NW 51ST PL
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-1929
Country	:	US
Telephone Number	:	954-778-7325
Fax Number	:

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

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/24/2017

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Directions to “ JONATHAN SCHAEFER ” Practice Location

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