Provider Demographics
NPI:1386603561
Name:SCHEXNAYDRE, EVON LOUISE (MD)
Entity type:Individual
Prefix:
First Name:EVON
Middle Name:LOUISE
Last Name:SCHEXNAYDRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EXPLORER ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2813
Mailing Address - Country:US
Mailing Address - Phone:906-483-1130
Mailing Address - Fax:906-483-1394
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1050
Practice Address - Fax:906-372-3230
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDF4619OtherMEDICARE RR GRP PIN
MI0701138OtherBCBSM IND PIN
MI0P31360OtherMEDICARE GRP PIN
MI0G01131OtherBCBSM GRP PIN
MI0701138OtherBCBSM IND PIN
MIP31360009Medicare PIN