Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | IL |
NPI | 1114967205 |
---|---|
Provider Name | Dr. Jerome E. Schoen |
First Address | Northfield, IL 60093-4303 |
Second Address | Barrington, IL 60010-3396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80002564 | BCBS PROVIDER NUMBER (01) | IL |
T35544 | (02) | IL |