Provider Demographics
NPI:1245860964
Name:SCHOTT, LISA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SCHOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 N 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-9751
Mailing Address - Country:US
Mailing Address - Phone:772-872-2302
Mailing Address - Fax:
Practice Address - Street 1:1881 N 11 MILE RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:MI
Practice Address - Zip Code:48634-9751
Practice Address - Country:US
Practice Address - Phone:772-872-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant