Basic Information
| Provider Information | |||||||||
| NPI: | 1609938414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTOPHER B SCHOOLEY DO, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 673400 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482670001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344620340 | ||||||||
| FaxNumber: | 7344620344 | ||||||||
| Practice Location | |||||||||
| Address1: | 19460 GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482231200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133871047 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHOOLEY | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3133871047 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 5101010057 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | CS010057 | 01 | MI | STATE LICENSE | OTHER |