Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | IL |
NPI | 1003980624 |
---|---|
Provider Name | Dr. Annette A Scheetz |
First Address | Chicago, IL 60647-3120 |
Second Address | Chicago, IL 60647-3120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01627182 | BCBSIL (01) | IL |
C45670 | (02) |