Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 023430-1 | NY |
NPI | 1205397866 |
---|---|
Provider Name | Mr. Travis Stephen Schake |
First Address | Churchville, NY 14428-9407 |
Second Address | Orchard Park, NY 14127-2291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |