Healthcare Provider Details

I. General information

NPI: 1285811539
Provider Name (Legal Business Name): JOEL A. SCHNEIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S FOX MILL LN
SPRINGFIELD IL
62712-9520
US

IV. Provider business mailing address

120 S FOX MILL LN
SPRINGFIELD IL
62712-9520
US

V. Phone/Fax

Practice location:
  • Phone: 217-553-1990
  • Fax: 217-585-0315
Mailing address:
  • Phone: 217-553-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: