Provider Demographics
NPI:1093014219
Name:SCHORFHEIDE, PHILLIP L (NP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:L
Last Name:SCHORFHEIDE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16808 ARBOR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5252
Mailing Address - Country:US
Mailing Address - Phone:773-391-3600
Mailing Address - Fax:
Practice Address - Street 1:16808 ARBOR CREEK DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5252
Practice Address - Country:US
Practice Address - Phone:773-391-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner