Provider Demographics
NPI:1639282114
Name:SCHROEDER, MICHAEL R (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 WEST MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006
Mailing Address - Country:US
Mailing Address - Phone:269-349-9817
Mailing Address - Fax:269-349-9817
Practice Address - Street 1:4021 WEST MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006
Practice Address - Country:US
Practice Address - Phone:269-349-9817
Practice Address - Fax:269-349-9817
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist