Provider Demographics
NPI:1629053806
Name:DOV SCHUCHMAN MD PC
Entity Type:Organization
Organization Name:DOV SCHUCHMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-334-4211
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT 77446
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:248-334-4211
Mailing Address - Fax:248-332-9377
Practice Address - Street 1:43700 WOODWARD AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5058
Practice Address - Country:US
Practice Address - Phone:248-334-4211
Practice Address - Fax:248-332-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION91310Medicare ID - Type Unspecified