Healthcare Provider Details

I. General information

NPI: 1073194288
Provider Name (Legal Business Name): LUKE JAMES SCHAFFER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N SOMMER ST STE 608
PEORIA IL
61615-1968
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1308
US

V. Phone/Fax

Practice location:
  • Phone: 309-676-5546
  • Fax:
Mailing address:
  • Phone: 708-495-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036181028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: