Provider Demographics
NPI:1083781587
Name:SCHNEIDER, SUSAN M (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MADISON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6572
Mailing Address - Country:US
Mailing Address - Phone:815-725-3340
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON ST STE 104
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-725-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089059208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG59552Medicare UPIN
IL548220Medicare ID - Type UnspecifiedMEDICARE