Provider Demographics
NPI:1508492877
Name:SCHOONOVER, MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7510
Mailing Address - Country:US
Mailing Address - Phone:865-685-0767
Mailing Address - Fax:865-685-0097
Practice Address - Street 1:441 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7510
Practice Address - Country:US
Practice Address - Phone:865-685-0767
Practice Address - Fax:865-685-0097
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5324363A00000X
NC0010-09733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-09733OtherNORTH CAROLINA MEDICAL BOARD