Healthcare Provider Details

I. General information

NPI: 1881894541
Provider Name (Legal Business Name): VIRGINIA M SCHMIDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 S WESTERN AVE
CHICAGO IL
60608-3837
US

IV. Provider business mailing address

966 W 21ST ST
CHICAGO IL
60608-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax: 312-829-6375
Mailing address:
  • Phone: 773-254-1400
  • Fax: 312-829-6375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036116600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: