Provider Demographics
NPI:1629269949
Name:SCHUCHARD, MARK ALAN (IDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:SCHUCHARD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 ALFA 6TH STREET
Mailing Address - Street 2:MABLE HOSPITAL GREAT LAKES
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-5230
Mailing Address - Country:US
Mailing Address - Phone:847-688-5523
Mailing Address - Fax:
Practice Address - Street 1:4182 HAMEHAME ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-6824
Practice Address - Country:US
Practice Address - Phone:858-717-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman