Healthcare Provider Details

I. General information

NPI: 1598203523
Provider Name (Legal Business Name): KEN J. SCHAFFER APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEN J. SCHAFFER CNP

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-2210
  • Fax: 847-696-3394
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209015091
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: