MEDICARE: DR. JEFFREY J SCHAIDER MD

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	207P00000X	Emergency Medicine Physician	036079017	IL

General Provider Information

NPI Number	:	1750463238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY J SCHAIDER MD

Provider Business Mailing Address
First Line	:	1115 ASHLAND AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1437
Country	:	US
Telephone Number	:	708-366-1402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W POLK ST
Second Line	:	DEPT OF EMERGENCY MEDICINE ROOM 1035
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-0066
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	04/30/2021

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