=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285335612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INITIUM INFUSIONS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2023
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 SALT CREEK LN STE 410
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-8624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-389-4853
-----------------------------------------------------
Fax | 312-586-7972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 W MAPLE ST
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-835-9973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. KATHLEEN S SCHMELKA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 312-835-9973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------