Provider Demographics
NPI:1780728980
Name:SCHAACK, TERRY M (MD)
Entity type:Individual
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First Name:TERRY
Middle Name:M
Last Name:SCHAACK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9675 BRIGHTON WAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5100
Mailing Address - Country:US
Mailing Address - Phone:310-550-8543
Mailing Address - Fax:310-550-0823
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:SUITE 290
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5100
Practice Address - Country:US
Practice Address - Phone:310-550-8543
Practice Address - Fax:310-550-0823
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA43132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE01670Medicare UPIN