Provider Demographics
NPI:1912002999
Name:SCHUMACHER, RANDOLPH E (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:E
Last Name:SCHUMACHER
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 1:1409 S GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3538
Mailing Address - Country:US
Mailing Address - Phone:810-235-2599
Mailing Address - Fax:810-235-2836
Practice Address - Street 1:2700 ROBERT T LONGWAY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2190
Practice Address - Country:US
Practice Address - Phone:810-235-2599
Practice Address - Fax:810-235-2836
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405199207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102510081OtherBLUE SHIELD
MI4511654Medicaid
MI1102510081OtherBLUE SHIELD
MIP23940004Medicare PIN