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NPI Code Detail

MEDICARE: JAMIE HODGE SCHUBERT PA

MEDICARE: JAMIE HODGE SCHUBERT PA
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
1363A00000XPhysician Assistant085006880IL

General Provider Information

NPI Number : 1447721790
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE HODGE SCHUBERT PA
Provider Business Mailing Address
First Line : 2151 W DIVISION ST # 202E
Second Line :
City : CHICAGO
State : IL
Zip : 60622-3056
Country : US
Telephone Number : 630-642-0312
Fax Number :
Provider Business Practice Location Address
First Line : 3665 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60613-4567
Country : US
Telephone Number : 773-496-4433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2018
Last Update Date : 12/16/2018

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Directions to “ JAMIE HODGE SCHUBERT PA” Practice Location

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