Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 036084198 | IL |
NPI | 1003914292 |
---|---|
Provider Name | Joseph Raymond Schneider |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036084198 | (05) | IL |
206147 | MEDICARE GOUP NUMBER (01) | IL |
E12741 | (02) | |
P00443374 | MEDICARE RAILROAD (01) | IL |