Basic Information
| Provider Information | |||||||||
| NPI: | 1043878804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHERMER | ||||||||
| FirstName: | WESLEY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776982 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316722119 | ||||||||
| FaxNumber: | 3134327759 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W SAVIDGE ST | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494561620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316723100 | ||||||||
| FaxNumber: | 2316723102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5151013920 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1043878804 | 05 | MI | MEDICAID |