Provider Demographics
NPI:1003914292
Name:SCHNEIDER, JOSEPH RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4487
Mailing Address - Fax:630-933-2009
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4487
Practice Address - Fax:630-933-2009
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360841982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE GOUP NUMBER
IL036084198Medicaid
ILP00443374OtherMEDICARE RAILROAD
E12741Medicare UPIN
ILP00443374OtherMEDICARE RAILROAD