Provider Demographics
NPI:1255384335
Name:SCHRADER, DEAN A (PA-C)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:SCHRADER
Suffix:
Gender:M
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 1:8333 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-8133
Mailing Address - Country:US
Mailing Address - Phone:616-225-0221
Mailing Address - Fax:
Practice Address - Street 1:8333 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-8133
Practice Address - Country:US
Practice Address - Phone:616-225-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00644989OtherRAILROAD MEDICARE
MI5341015OtherBCBS
MIP29950027Medicare PIN
MIN30180021Medicare PIN
MI5341015OtherBCBS
S87453Medicare UPIN