Basic Information
| Provider Information | |||||||||
| NPI: | 1972035012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAK | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | #220 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192915150 | ||||||||
| FaxNumber: | 4194796173 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 SEAGATE | ||||||||
| Address2: | #800 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851983 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.020739 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.