=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851611743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE FAY SCHWARZ D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2010
-----------------------------------------------------
Last Update Date | 12/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3325 N. ARLINGTON HEIGHTS RD. SUITE 100A
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-398-0400
-----------------------------------------------------
Fax | 847-398-9590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3325 N. ARLINGTON HEIGHTS RD. SUITE 100A
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-398-0400
-----------------------------------------------------
Fax | 847-398-9590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 125.058107
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------