Provider Demographics
NPI:1902807712
Name:SCHANTZ, MICHAEL E (BC-HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:SCHANTZ
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-1819
Mailing Address - Country:US
Mailing Address - Phone:812-847-4034
Mailing Address - Fax:812-847-4308
Practice Address - Street 1:30 MAIN ST S
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1819
Practice Address - Country:US
Practice Address - Phone:812-847-4034
Practice Address - Fax:812-847-4308
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000881A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000201420OtherBLUE CROSS