Healthcare Provider Details

I. General information

NPI: 1790179604
Provider Name (Legal Business Name): ANDREW SCHWEMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST STE 340
CHICAGO IL
60622-2995
US

IV. Provider business mailing address

2222 W DIVISION ST STE 340
CHICAGO IL
60622-2995
US

V. Phone/Fax

Practice location:
  • Phone: 773-541-8100
  • Fax: 773-541-8109
Mailing address:
  • Phone: 773-541-8100
  • Fax: 773-541-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME144221
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.157404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: