MEDICARE: MATTHEW THOMAS SCHELDRUP ATC, LAT

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	2255A2300X	Athletic Trainer	2000013385	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000013385	OTHER	IL	CERTIFIED ATHLETIC TRAINER
2	096003663	OTHER	IL	LICENSED ATHLETIC TRAINER

General Provider Information

NPI Number	:	1598262750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW THOMAS SCHELDRUP ATC, LAT

Provider Business Mailing Address
First Line	:	1141 N MITCHELL AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4622
Country	:	US
Telephone Number	:	847-271-5032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 N MITCHELL AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4622
Country	:	US
Telephone Number	:	847-271-5032
Fax Number	:

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	04/12/2018

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