Provider Demographics
NPI:1619935756
Name:SCHUCHMAN, DOV (MD)
Entity Type:Individual
Prefix:
First Name:DOV
Middle Name:
Last Name:SCHUCHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOV
Other - Middle Name:
Other - Last Name:SCHUCHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:DEPT 77446
Mailing Address - Street 2:PO BOX 77000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0001
Mailing Address - Country:US
Mailing Address - Phone:248-334-4211
Mailing Address - Fax:
Practice Address - Street 1:2550 S TELEGRAPH RD
Practice Address - Street 2:SUITE 107B
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-334-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042149207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104271698Medicaid
MIA80160Medicare UPIN
MI104271698Medicaid