MEDICARE: LESLIE SCHAFFER 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	207T00000X	Neurological Surgery Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0859703	OTHER		AETNA
2	0001617222	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1447234752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE SCHAFFER MD

Provider Business Mailing Address
First Line	:	25 E WASHINGTON ST
Second Line	:	SUITE 1329
City	:	CHICAGO
State	:	IL
Zip	:	60602-1708
Country	:	US
Telephone Number	:	312-704-0177
Fax Number	:	312-704-1938

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST
Second Line	:	SUITE 1329
City	:	CHICAGO
State	:	IL
Zip	:	60602-1708
Country	:	US
Telephone Number	:	312-704-0177
Fax Number	:	312-704-1938

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	11/06/2007

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