Basic Information
| Provider Information | |||||||||
| NPI: | 1013449792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOENHEIT | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 HAGADORN RD | ||||||||
| Address2: | |||||||||
| City: | GRAYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183848521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5333 MCAULEY DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347123980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2017 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.