Basic Information
Provider Information | |||||||||
NPI: | 1245253392 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHUIL | ||||||||
FirstName: | DUANE | ||||||||
MiddleName: | W | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD, PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2800 E MITCHELL RD | ||||||||
Address2: |   | ||||||||
City: | PETOSKEY | ||||||||
State: | MI | ||||||||
PostalCode: | 497709026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2318383375 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 560 W MITCHELL ST | ||||||||
Address2: | SUITE 400 | ||||||||
City: | PETOSKEY | ||||||||
State: | MI | ||||||||
PostalCode: | 497702275 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2314872490 | ||||||||
FaxNumber: | 2314876055 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2006 | ||||||||
LastUpdateDate: | 12/05/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 4301053846 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 4301053846 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
ID | Type | State | Issuer | Description | P54419 | 01 | MI | BLUE CARE NETWORK | OTHER | 0602408771 | 01 | MI | BLUE SHIELD INDIVIDUAL PI | OTHER | 4087243 | 05 | MI |   | MEDICAID |