Basic Information
| Provider Information | |||||||||
| NPI: | 1427160068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMOKE | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHMOKE | ||||||||
| OtherFirstName: | RAYMOND | ||||||||
| OtherMiddleName: | E.F. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| 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: | 08/31/2006 | ||||||||
| LastUpdateDate: | 01/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301047408 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1748544 | 05 | MI | MEDICAID |