Healthcare Provider Details

I. General information

NPI: 1003889957
Provider Name (Legal Business Name): JENNIFER S SCHROEDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 01/17/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 PITTSFIELD RD
MOUNT STERLING IL
62353
US

IV. Provider business mailing address

521 E MAIN ST
MT STERLING IL
62353-1378
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-3963
  • Fax: 217-773-3426
Mailing address:
  • Phone: 217-773-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036108903
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: