Basic Information
| Provider Information | |||||||||
| NPI: | 1245201607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUSTER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 760 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172052700 | ||||||||
| FaxNumber: | 5172052700 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172052700 | ||||||||
| FaxNumber: | 5172052720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 4301046075 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4565932 | 05 | MI | MEDICAID | 279500 | 01 | IL | MEDICARE GROUP | OTHER | 12-00399 | 01 | MI | PHP | OTHER | 1245201607 | 05 | IL | MEDICAID | P26198F | 01 | MI | BCN | OTHER | 350190010 | 01 | MI | BCBS | OTHER |