Provider Demographics
NPI:1720114036
Name:SCHAEFFER, MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1753
Mailing Address - Country:US
Mailing Address - Phone:215-843-3668
Mailing Address - Fax:215-613-5298
Practice Address - Street 1:4041 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1753
Practice Address - Country:US
Practice Address - Phone:215-843-3668
Practice Address - Fax:215-613-5298
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001458L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060704000OtherHIGHMARK BLUE SHIELD
PA0060704000OtherHIGHMARK BLUE SHIELD