MEDICARE: DR. GARY EDWARD SCHAFFEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036093564	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205568397	OTHER		TAX IDENTIFICATION

General Provider Information

NPI Number	:	1336123884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY EDWARD SCHAFFEL M.D.

Provider Business Mailing Address
First Line	:	990 S WAUKEGAN RD STE 200
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2654
Country	:	US
Telephone Number	:	847-234-8100
Fax Number	:	847-234-8199

Provider Business Practice Location Address
First Line	:	990 S WAUKEGAN RD STE 200
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2654
Country	:	US
Telephone Number	:	847-234-8100
Fax Number	:	847-234-8199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/05/2024

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