Healthcare Provider Details

I. General information

NPI: 1619279288
Provider Name (Legal Business Name): MICHAEL E SCHAFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N DAYTON ST
CHICAGO IL
60614-3611
US

IV. Provider business mailing address

2225 N DAYTON ST
CHICAGO IL
60614-3611
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-9013
  • Fax:
Mailing address:
  • Phone: 773-472-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number36-42672
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: