Provider Demographics
NPI:1205043353
Name:SCHLACHT, ALISA M (DO)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:M
Last Name:SCHLACHT
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 1:714 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2490
Mailing Address - Country:US
Mailing Address - Phone:517-618-8969
Mailing Address - Fax:
Practice Address - Street 1:714 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2490
Practice Address - Country:US
Practice Address - Phone:517-376-5174
Practice Address - Fax:517-618-8969
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010163912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry