Provider Demographics
NPI:1629018635
Name:SCHAFER, MICHAEL W (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 KENT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-1707
Mailing Address - Country:US
Mailing Address - Phone:517-647-4166
Mailing Address - Fax:517-647-2473
Practice Address - Street 1:406 KENT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-1707
Practice Address - Country:US
Practice Address - Phone:517-647-4166
Practice Address - Fax:517-647-2473
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1008612OtherMCLAREN HEALTH ADVANTAGE
MI200000002664OtherPHP FAMILYCARE
MI200000002664OtherPHP
MI7182486OtherAETNA
MI4522012Medicaid
MI0803400412OtherBCBS/BCN
MI0M21440028OtherMEDICARE ADVANTAGE
MI1008612OtherMCLAREN HEALTH PLAN-COMMERCIAL
MIP00053237OtherRAILROAD MEDICARE
MI1008612OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000002664OtherPHP
MI200000002664OtherPHP FAMILYCARE