Provider Demographics
NPI:1346437316
Name:RAYMOND E. F. SCHMOKE, MD. P.C.
Entity type:Organization
Organization Name:RAYMOND E. F. SCHMOKE, MD. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EF
Authorized Official - Last Name:SCHMOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-723-3567
Mailing Address - Street 1:1806 EAST PARKDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660
Mailing Address - Country:US
Mailing Address - Phone:231-723-3567
Mailing Address - Fax:231-723-1767
Practice Address - Street 1:1806 EAST PARKDALE AVENUE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660
Practice Address - Country:US
Practice Address - Phone:231-723-3567
Practice Address - Fax:231-723-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101748544Medicaid
B44063Medicare UPIN
MI101748544Medicaid