Provider Demographics
NPI:1760485536
Name:SCHAFFER, PETER ERIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ERIC
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N OLD WOODWARD AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1318
Mailing Address - Country:US
Mailing Address - Phone:248-594-3338
Mailing Address - Fax:248-594-3341
Practice Address - Street 1:600 N OLD WOODWARD AVE
Practice Address - Street 2:STE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1318
Practice Address - Country:US
Practice Address - Phone:248-594-3338
Practice Address - Fax:248-594-3341
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000620213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5635004OtherBCBS PIN
MI133348336Medicaid
MI5825307Medicare PIN
MI4650420001Medicare NSC
MI5635004OtherBCBS PIN
MIU21876Medicare UPIN