Provider Demographics
NPI:1154328722
Name:SCHENEWERK, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SCHENEWERK
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 1:4017 ILLINOIS STATE ROUTE 159
Mailing Address - Street 2:STE. 101
Mailing Address - City:SMITHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62285
Mailing Address - Country:US
Mailing Address - Phone:618-257-2875
Mailing Address - Fax:618-257-2895
Practice Address - Street 1:4017 ILLINOIS STATE ROUTE 159
Practice Address - Street 2:STE. 101
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285-9998
Practice Address - Country:US
Practice Address - Phone:618-257-2875
Practice Address - Fax:618-257-2895
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1154328722Medicaid
IL036099178Medicaid
ILIL3374004Medicare PIN
ILG99390Medicare UPIN