Healthcare Provider Details

I. General information

NPI: 1649641945
Provider Name (Legal Business Name): MARY SCHUM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST STE 160
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

600 S PAULINA SUITE 160
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3333
  • Fax:
Mailing address:
  • Phone: 312-942-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: