Provider Demographics
NPI:1063810653
Name:SCHAFFERT, DENISE KAY (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:KAY
Last Name:SCHAFFERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:KAY WONTORCIK
Other - Last Name:SCHAFFERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:920 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2700
Mailing Address - Country:US
Mailing Address - Phone:989-839-9937
Mailing Address - Fax:989-839-9220
Practice Address - Street 1:920 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2700
Practice Address - Country:US
Practice Address - Phone:989-839-9937
Practice Address - Fax:989-839-9220
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics