Healthcare Provider Details

I. General information

NPI: 1316223589
Provider Name (Legal Business Name): DREW SCHAAFSMA PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 ROLLINGRIDGE RD STE 102
NAPERVILLE IL
60564-4234
US

IV. Provider business mailing address

2940 ROLLINGRIDGE RD STE 102
NAPERVILLE IL
60564-4234
US

V. Phone/Fax

Practice location:
  • Phone: 630-579-6500
  • Fax: 630-718-6075
Mailing address:
  • Phone: 630-579-6500
  • Fax: 630-718-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096002713
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: