Provider Demographics
NPI:1053335018
Name:SCHRAM, JON L (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:L
Last Name:SCHRAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2608
Practice Address - Country:US
Practice Address - Phone:616-994-6677
Practice Address - Fax:616-494-5901
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460607Medicare PIN
A78721Medicare UPIN