Organization
SOUTHERN GRAND TRAVERSE MEDICAL
Active
Organization
SOUTHERN GRAND TRAVERSE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY J SCHAUB PA-C (OWNER)
(231) 995-4902
Entity
Organization
Contact information
Practice address
401 MUNSON AVE, TRAVERSE CITY, MI 49686-3041
(231) 995-4902
(231) 932-7816
Mailing address
401 MUNSON AVE, TRAVERSE CITY, MI 49686-3041
(231) 995-4902
(231) 932-7816
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601001376
MI
Other
Enumeration date
10/16/2007
Last updated
10/16/2007
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