Provider Demographics
NPI:1558441154
Name:SCHUBERT, A. WILLIAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:A. WILLIAM
Middle Name:G
Last Name:SCHUBERT
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 1:1605 REYNOLDS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3152
Mailing Address - Country:US
Mailing Address - Phone:217-348-0221
Mailing Address - Fax:217-345-1380
Practice Address - Street 1:1605 REYNOLDS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3152
Practice Address - Country:US
Practice Address - Phone:217-348-0221
Practice Address - Fax:217-345-1380
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03654317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0305630001OtherNATIONAL GOVERNMENT SERVICES
IL227630Medicare PIN
ILD86571Medicare UPIN
IL036054317Medicare ID - Type Unspecified