Provider Demographics
NPI:1922606193
Name:SCHULZE GONI, THATIANA CAROLINA (MD, MMS, MHS)
Entity Type:Individual
Prefix:DR
First Name:THATIANA
Middle Name:CAROLINA
Last Name:SCHULZE GONI
Suffix:
Gender:F
Credentials:MD, MMS, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 N LINCOLN AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3736
Mailing Address - Country:US
Mailing Address - Phone:773-680-9526
Mailing Address - Fax:
Practice Address - Street 1:5924 N LINCOLN AVE APT 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3736
Practice Address - Country:US
Practice Address - Phone:773-680-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125077259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine