MEDICARE: JEFFREY MICHAEL SCHENCK DO

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	207Q00000X	Family Medicine Physician	036157832	IL

General Provider Information

NPI Number	:	1447713409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MICHAEL SCHENCK DO

Provider Business Mailing Address
First Line	:	5 LUDWIG DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1332
Country	:	US
Telephone Number	:	618-397-9000
Fax Number	:	618-397-9003

Provider Business Practice Location Address
First Line	:	5 LUDWIG DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1332
Country	:	US
Telephone Number	:	618-397-9000
Fax Number	:	618-397-9003

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

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	12/30/2022

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