MEDICARE: JACQUELYN C SCHNIDMAN 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	208000000X	Pediatrics Physician	R9A43	MO

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	:	1508850462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN C SCHNIDMAN MD

Provider Business Mailing Address
First Line	:	4217 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-638-7330
Fax Number	:	314-638-3614

Provider Business Practice Location Address
First Line	:	4217 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-638-7330
Fax Number	:	314-638-3614

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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