Provider Demographics
NPI:1922590652
Name:SCHAEFER, MAX (DO)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LONGMEADOW VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7809
Mailing Address - Country:US
Mailing Address - Phone:269-684-6000
Mailing Address - Fax:269-684-1388
Practice Address - Street 1:4 LONGMEADOW VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-7809
Practice Address - Country:US
Practice Address - Phone:269-684-6000
Practice Address - Fax:269-684-1388
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3111207Q00000X
METP18025390200000X
MI5101027033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program