Provider Demographics
NPI:1942384649
Name:SCHNEIDER, JULI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JULI
Middle Name:LYNN
Last Name:SCHNEIDER
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 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-624-8818
Mailing Address - Fax:309-624-8820
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-624-8818
Practice Address - Fax:309-624-8820
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL26945208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC269453Medicaid
SCP00648615OtherRAILROAD MEDICARE ID
SCGP4841OtherMEDICAID GROUP #
SCP00775517OtherRAILROAD MEDICARE ID-AFTER 5/1/2009
SCP00775517OtherRAILROAD MEDICARE ID-AFTER 5/1/2009
SCAA30299223Medicare PIN