Provider Demographics
NPI:1336238559
Name:CHARLES W SCHISLER, D.O., P.C.
Entity Type:Organization
Organization Name:CHARLES W SCHISLER, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHISLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-892-4586
Mailing Address - Street 1:701 E VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4963
Mailing Address - Country:US
Mailing Address - Phone:989-892-4586
Mailing Address - Fax:989-892-2901
Practice Address - Street 1:701 E VERMONT ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4971
Practice Address - Country:US
Practice Address - Phone:989-892-4586
Practice Address - Fax:989-892-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS006239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1035904Medicaid
MICS006239OtherMI LICENSE
MIE25637Medicare UPIN
MICS006239OtherMI LICENSE
MI1035904Medicaid