Provider Demographics
NPI:1992721765
Name:SCHRAUBEN, DOUGLAS J (DO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:SCHRAUBEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 THREE LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5523
Mailing Address - Country:US
Mailing Address - Phone:989-779-5600
Mailing Address - Fax:989-772-4084
Practice Address - Street 1:2600 THREE LEAVES DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5523
Practice Address - Country:US
Practice Address - Phone:989-779-5600
Practice Address - Fax:989-772-4084
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E25760Medicare UPIN