Provider Demographics
NPI:1104105444
Name:SCHILB, MIKAEL P (DO)
Entity type:Individual
Prefix:MR
First Name:MIKAEL
Middle Name:P
Last Name:SCHILB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GENDER RD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-2007
Mailing Address - Country:US
Mailing Address - Phone:614-834-8042
Mailing Address - Fax:614-837-8035
Practice Address - Street 1:6201 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2007
Practice Address - Country:US
Practice Address - Phone:614-834-8042
Practice Address - Fax:614-837-8035
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34.012165OtherOH LICENSE
OH0177087Medicaid
MI5101019610OtherMEDICAL LICENSE NUMBER
OH58.005267OtherOHIO TRAINING CERTIFICATE CREDENTIAL