Healthcare Provider Details

I. General information

NPI: 1013031012
Provider Name (Legal Business Name): CAROLE ANN SCHAFFER M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4337 WISCONSIN AVE
STICKNEY IL
60402-4261
US

IV. Provider business mailing address

4337 WISCONSIN AVE
STICKNEY IL
60402-4261
US

V. Phone/Fax

Practice location:
  • Phone: 708-655-3711
  • Fax: 708-749-3716
Mailing address:
  • Phone: 708-655-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number227.001336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: