Provider Demographics
NPI:1568487940
Name:SCHOTT, RANDY L (PA-C)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:SCHOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6371
Mailing Address - Country:US
Mailing Address - Phone:517-203-3965
Mailing Address - Fax:517-203-3976
Practice Address - Street 1:830 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6371
Practice Address - Country:US
Practice Address - Phone:517-203-3965
Practice Address - Fax:517-203-3976
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601003351OtherSTATE LICENSE