Healthcare Provider Details

I. General information

NPI: 1326022278
Provider Name (Legal Business Name): MICHAEL C SCHNEIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ADRIENNE LN
WYNNEWOOD PA
19096-1205
US

IV. Provider business mailing address

119 ADRIENNE LN
WYNNEWOOD PA
19096-1205
US

V. Phone/Fax

Practice location:
  • Phone: 217-553-1516
  • Fax:
Mailing address:
  • Phone: 217-553-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD041918E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number036-101514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: