Provider Demographics
NPI:1003980624
Name:SCHEETZ, ANNETTE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:A
Last Name:SCHEETZ
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 1:2417 W MEDILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3120
Mailing Address - Country:US
Mailing Address - Phone:773-645-7070
Mailing Address - Fax:773-645-7316
Practice Address - Street 1:2417 W MEDILL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3120
Practice Address - Country:US
Practice Address - Phone:773-645-7070
Practice Address - Fax:773-645-7316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01627182OtherBCBSIL
IL01627182OtherBCBSIL
IL606220Medicare ID - Type Unspecified