Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | IL |
NPI | 1588649461 |
---|---|
Provider Name | Prof. Thomas J. Schnitzer |
First Address | Chicago, IL 60611-3006 |
Second Address | Chicago, IL 60611-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B48019 | (02) |