Healthcare Provider Details

I. General information

NPI: 1679624688
Provider Name (Legal Business Name): ALBERT SCHULTEIS MAURER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 TREMONT ST
HOPEDALE IL
61747-0295
US

IV. Provider business mailing address

502 TREMONT ST
HOPEDALE IL
61747-0295
US

V. Phone/Fax

Practice location:
  • Phone: 309-449-3301
  • Fax: 309-449-3511
Mailing address:
  • Phone: 309-449-3301
  • Fax: 309-449-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: