Provider Demographics
NPI:1427144724
Name:ALAN J SCHRAM DPM PC
Entity type:Organization
Organization Name:ALAN J SCHRAM DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-386-7920
Mailing Address - Street 1:6704 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2034
Mailing Address - Country:US
Mailing Address - Phone:313-386-7920
Mailing Address - Fax:313-382-7890
Practice Address - Street 1:6704 PARK AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2034
Practice Address - Country:US
Practice Address - Phone:313-386-7920
Practice Address - Fax:313-382-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS400226213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3094459Medicaid
MI480H201780OtherBCBSM
MION6603Medicare PIN
MI480H201780OtherBCBSM
MIT34390Medicare UPIN