Provider Demographics
NPI:1710053020
Name:SCHLABACH, JAY LYNN (MD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:LYNN
Last Name:SCHLABACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-2413
Mailing Address - Country:US
Mailing Address - Phone:574-533-7600
Mailing Address - Fax:574-533-7666
Practice Address - Street 1:400 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-2413
Practice Address - Country:US
Practice Address - Phone:574-533-7600
Practice Address - Fax:574-533-7666
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032927A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine