Provider Demographics
NPI:1902327869
Name:SCHAEFER, THOMAS RICHARD (NP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2738
Mailing Address - Country:US
Mailing Address - Phone:810-853-5875
Mailing Address - Fax:586-279-4515
Practice Address - Street 1:700 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2738
Practice Address - Country:US
Practice Address - Phone:810-853-5875
Practice Address - Fax:586-279-4515
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301351363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health