Provider Demographics
NPI:1306932611
Name:SCHAAF, MARK (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SCHAAF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4485 E MOUNT MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-8963
Mailing Address - Country:US
Mailing Address - Phone:810-640-1942
Mailing Address - Fax:810-640-1956
Practice Address - Street 1:4485 E MOUNT MORRIS RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-8963
Practice Address - Country:US
Practice Address - Phone:810-640-1942
Practice Address - Fax:810-640-1942
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMS013800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114568764Medicaid
MI0856306045OtherBCBS
MI0N96340001Medicare PIN
MI114568764Medicaid