Provider Demographics
NPI:1154872349
Name:SCHOEMAKER, ALBERT ALEXANDER (PT)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:ALEXANDER
Last Name:SCHOEMAKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1711
Mailing Address - Country:US
Mailing Address - Phone:734-455-8370
Mailing Address - Fax:
Practice Address - Street 1:650 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1711
Practice Address - Country:US
Practice Address - Phone:734-455-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501300629172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679530612OtherFACILITY NPI