Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2008007457 | MO |
Y | 207YS0123X | Facial Plastic Surgeon | 036136023 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 2008007457 | MO |
N | 207YS0123X | Facial Plastic Surgeon | 54586 | MN |
NPI | 1386892172 |
---|---|
Provider Name | Mary L Schinkel |
First Address | Alton, IL 62002-6751 |
Second Address | Alton, IL 62002-6751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2008 |
Last Update Date | 26/11/2021 |