MEDICARE: DR. JESSEN DEAN SCHIEBOUT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	036.130861	IL
2	207P00000X	Emergency Medicine Physician	036130861	IL
3	207P00000X	Emergency Medicine Physician	35.098086	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225272172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSEN DEAN SCHIEBOUT MD

Provider Business Mailing Address
First Line	:	765 W ADAMS ST APT 1813
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-3522
Country	:	US
Telephone Number	:	847-361-4492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1653 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3833
Country	:	US
Telephone Number	:	312-947-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	02/17/2026

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