Basic Information
| Provider Information | |||||||||
| NPI: | 1205397866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAKE | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 CHISWICK DR | ||||||||
| Address2: | |||||||||
| City: | CHURCHVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144289407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857704068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5959 BIG TREE RD | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141272291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162043200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 023430-1 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.