Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038007445 | IL |
N | 111NN0400X | Neurology | 4861-12 | WI |
NPI | 1053302372 |
---|---|
Provider Name | Dr. Scott E Schichtl |
First Address | Lindenhurst, IL 60046-1706 |
Second Address | Lindenhurst, IL 60046-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1669453056 | FACILITY NPI (01) | IL |
350054547 | MEDICARE RAILROAD # (01) | IL |
U32828 | (02) | IL |