Provider Demographics
NPI:1538200019
Name:SCHELBERG, JAMES (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SCHELBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRISWOLD ST
Mailing Address - Street 2:STE 1B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3480
Mailing Address - Country:US
Mailing Address - Phone:313-962-4555
Mailing Address - Fax:
Practice Address - Street 1:500 GRISWOLD ST
Practice Address - Street 2:STE 1B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3480
Practice Address - Country:US
Practice Address - Phone:313-962-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000836213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13-1440728Medicaid
MI5825014OtherBLUE CROSS-PLYMOUTH
MI791480531AOtherRAILROAD MEDICARE
MI791480531OtherRAILROAD MEDICARE DETROIT
MI0P57800OtherMEDICARE PTAN
MI13-2097616Medicaid
MI791480531OtherRAILROAD MEDICARE DETROIT