Provider Demographics
NPI:1942247176
Name:SPORTS MEDICINE & JOINT CARE OF WEST MICHIGAN, PLC
Entity Type:Organization
Organization Name:SPORTS MEDICINE & JOINT CARE OF WEST MICHIGAN, PLC
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF KALAMAZOO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-978-0444
Mailing Address - Street 1:7901 S 12TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3831
Mailing Address - Country:US
Mailing Address - Phone:269-978-0444
Mailing Address - Fax:269-978-0447
Practice Address - Street 1:7901 S 12TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3831
Practice Address - Country:US
Practice Address - Phone:269-978-0444
Practice Address - Fax:269-978-0447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPORTS MEDICINE & JOINT CARE OF WEST MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
MI4301061042207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6063050001Medicare NSC
MIF24065Medicare UPIN
MI0P10690Medicare Oscar/Certification