Provider Demographics
NPI:1902881360
Name:SCHALL, JEANNE M (DO)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:SCHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 E TRAVERSE HWY STE 4400
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1320
Mailing Address - Country:US
Mailing Address - Phone:231-346-6800
Mailing Address - Fax:
Practice Address - Street 1:5640 N ADRIAN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8318
Practice Address - Country:US
Practice Address - Phone:517-577-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7175207R00000X
OH34007175207R00000X
MI510-102-0677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000205660OtherANTHEM
OH04102OtherPARAMOUNT
OH2237010Medicaid
OH000000205660OtherANTHEM
OH4043501Medicare PIN