Provider Demographics
NPI:1831115369
Name:SCHAFER, MICHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:SCHAFER
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-654-2283
Mailing Address - Fax:859-654-2284
Practice Address - Street 1:79 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:KY
Practice Address - Zip Code:41006-8704
Practice Address - Country:US
Practice Address - Phone:859-654-2283
Practice Address - Fax:859-654-2284
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64125990Medicaid
KYP00333230OtherRAILROAD MEDICARE
OH2739684Medicaid
KYP00839850OtherRAILROAD MEDICARE
KY09454057Medicare PIN
KY0387226Medicare PIN
KYP00839850OtherRAILROAD MEDICARE
KY008580044Medicare PIN