Provider Demographics
NPI:1043266406
Name:SCHLAEPFER, ALICE (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:SCHLAEPFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:3380 44TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2461
Practice Address - Country:US
Practice Address - Phone:616-685-8250
Practice Address - Fax:616-532-3564
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4194163Medicaid
MI4555022Medicaid
MI3489067Medicaid
MI4877269Medicaid
MI3415831Medicaid
MIM69390022Medicare ID - Type Unspecified
MIM02830045Medicare ID - Type Unspecified
MIP32930102Medicare ID - Type Unspecified
MIG13794Medicare UPIN