Provider Demographics
NPI:1003889957
Name:SCHROEDER, JENNIFER S (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1378
Mailing Address - Country:US
Mailing Address - Phone:217-773-3963
Mailing Address - Fax:
Practice Address - Street 1:216 PITTSFIELD RD
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353
Practice Address - Country:US
Practice Address - Phone:217-773-3963
Practice Address - Fax:217-773-3426
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24923Medicare PIN
H87774Medicare UPIN
ILP00384905Medicare PIN