Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036074782 | IL |
N | 2080P0207X | Pediatric Hematology-Oncologist | 036074782 | IL |
NPI | 1245240639 |
---|---|
Provider Name | Mary Lou Schmidt |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-7232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 12/01/2022 |