Basic Information
Provider Information
NPI: 1487041877
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHUT
FirstName: FREDRIC
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3290 SHASTA DR SE
Address2:  
City: CALEDONIA
State: MI
PostalCode: 493168467
CountryCode: US
TelephoneNumber: 6165412041
FaxNumber:  
Practice Location
Address1: 277 NORTH ST
Address2:  
City: ALLEGAN
State: MI
PostalCode: 490101138
CountryCode: US
TelephoneNumber: 2696735092
FaxNumber: 2696864601
Other Information
ProviderEnumerationDate: 04/23/2015
LastUpdateDate: 04/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X6802065609MIY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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