Provider Demographics
NPI:1548214539
Name:SCHRAUFNAGEL, MARY N (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
Last Name:SCHRAUFNAGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:STE L-120
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305
Mailing Address - Country:US
Mailing Address - Phone:708-488-1919
Mailing Address - Fax:708-488-2370
Practice Address - Street 1:7411 LAKE ST
Practice Address - Street 2:STE L-120
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305
Practice Address - Country:US
Practice Address - Phone:708-488-1919
Practice Address - Fax:708-488-2370
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062608Medicaid
0001634609OtherBLUE CROSS GROUP
P00144178OtherMEDICARE RAILROAD
IL036062608Medicaid