Provider Demographics
NPI:1689137648
Name:SCHIFFENHAUS, MICHAEL ADAM
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:SCHIFFENHAUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-1060
Mailing Address - Country:US
Mailing Address - Phone:973-941-3502
Mailing Address - Fax:
Practice Address - Street 1:111 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-1060
Practice Address - Country:US
Practice Address - Phone:973-941-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman