Provider Demographics
NPI:1407868318
Name:SCHAEFER, ALEXANDER (RPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 N SOUTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7166
Mailing Address - Country:US
Mailing Address - Phone:773-472-2731
Mailing Address - Fax:773-472-2761
Practice Address - Street 1:2533 N SOUTHPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7166
Practice Address - Country:US
Practice Address - Phone:773-472-2731
Practice Address - Fax:773-472-2761
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2174225100000X
IL070012480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0238111OtherHMSA, HMSA QUEST, 65CP
HI99017685996793OtherTRICARE CHAMPUS
HI478143OtherUHA
HIP74301Medicare UPIN
HIH100652Medicare PIN