Healthcare Provider Details

I. General information

NPI: 1245240639
Provider Name (Legal Business Name): MARY LOU SCHMIDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

840 S WOOD ST 1347 CSB, MC 856
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 866-660-2273
  • Fax:
Mailing address:
  • Phone: 312-996-1791
  • Fax: 312-413-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number036074782
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036074782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: