Basic Information
| Provider Information | |||||||||
| NPI: | 1760409387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUMAKER | ||||||||
| FirstName: | JONATHON | ||||||||
| MiddleName: | NORMAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | 8286516570 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLANDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287417600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285261200 | ||||||||
| FaxNumber: | 8285261230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
| 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 | 207P00000X | 38636 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301066056 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 4301066056 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 2016-02245 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 2016-02245 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1760409387 | 05 | MI | MEDICAID | 1417961137 | 01 | MI | BCBSM - BRONSON | OTHER | 4859064 | 05 | MI | MEDICAID |