Basic Information
| Provider Information | |||||||||
| NPI: | 1346437316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAYMOND E. F. SCHMOKE, MD. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1806 EAST PARKDALE AVENUE | ||||||||
| Address2: | |||||||||
| City: | MANISTEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317233567 | ||||||||
| FaxNumber: | 2317231767 | ||||||||
| Practice Location | |||||||||
| Address1: | 1806 EAST PARKDALE AVENUE | ||||||||
| Address2: | |||||||||
| City: | MANISTEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317233567 | ||||||||
| FaxNumber: | 2317231767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 11/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | SCHMOKE | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | E.F. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2317233567 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301047408 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101748544 | 05 | MI | MEDICAID |