MEDICARE: SCHULDT PERFORMANCE CENTER

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	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04922184	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1528128634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHULDT PERFORMANCE CENTER

Provider Business Mailing Address
First Line	:	636 RIDGE RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4361
Country	:	US
Telephone Number	:	847-579-1357
Fax Number	:	847-579-1359

Provider Business Practice Location Address
First Line	:	636 RIDGE RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4361
Country	:	US
Telephone Number	:	847-579-1357
Fax Number	:	847-579-1359

Authorized Official
Title or Position	:	OWNER
Name	:	BOB SCHULDT
Credential	:
Telephone Number	:	847-579-1357

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/02/2007

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Directions to “SCHULDT PERFORMANCE CENTER ” Practice Location

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