Healthcare Provider Details

I. General information

NPI: 1821134883
Provider Name (Legal Business Name): EDWARD MATTHEW SCHAEFFER M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 20-150
CHICAGO IL
60611-5979
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 2300
CHICAGO IL
60611-2915
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8146
  • Fax: 312-695-7030
Mailing address:
  • Phone: 312-926-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD65623
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: