Provider Demographics
NPI:1497948368
Name:DOCTOR SCHOENEICH MEDICAL OFFICE S. C.
Entity Type:Organization
Organization Name:DOCTOR SCHOENEICH MEDICAL OFFICE S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARZENNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOENEICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-534-6100
Mailing Address - Street 1:420 PENNSYLVANIA AVE
Mailing Address - Street 2:103
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4437
Mailing Address - Country:US
Mailing Address - Phone:630-534-6100
Mailing Address - Fax:630-534-6314
Practice Address - Street 1:420 PENNSYLVANIA AVE
Practice Address - Street 2:103
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4437
Practice Address - Country:US
Practice Address - Phone:630-534-6100
Practice Address - Fax:630-534-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1558460139OtherNPI
ILH11433Medicare UPIN
203052Medicare PIN