Provider Demographics
NPI:1033199930
Name:SCHAEFFER, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1654
Mailing Address - Country:US
Mailing Address - Phone:440-414-9200
Mailing Address - Fax:216-201-5582
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 127
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-414-9200
Practice Address - Fax:216-201-5582
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033728207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0311531Medicaid
OHE55728OtherSUMMACARE
OH000000128721OtherANTHEM
OH100409OtherKAISER
060013314OtherRAILROAD MEDICARE
OH341221800070OtherCARESOURCE
060013314OtherRAILROAD MEDICARE
OH0311531Medicaid
OH000000128721OtherANTHEM
OH4011394Medicare PIN