Provider Demographics
NPI:1437135431
Name:SCHRECK, PAULA KAY (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:SCHRECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22101 MOROSS RD
Mailing Address - Street 2:5 WEST
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2148
Mailing Address - Country:US
Mailing Address - Phone:313-343-3146
Mailing Address - Fax:313-417-1247
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:205
Practice Address - City:MACOMB TWP
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6250
Practice Address - Fax:586-226-6255
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4172308Medicaid
MI0E011720OtherBCBS GROUP NUMBER
MI0Q262160OtherBCBS GROUP NUMBER
MI0M92510Medicare PIN
F78460Medicare UPIN
MI0M71670Medicare PIN