Provider Demographics
NPI:1023086642
Name:SCHNECK, MICHAEL JOEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOEL
Last Name:SCHNECK
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 1:2160 S 1ST AVE
Mailing Address - Street 2:(MAGUIRE CENTER, RM. 2700)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-2662
Mailing Address - Fax:708-216-5617
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(MAGUIRE CENTER, RM. 2700)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-2662
Practice Address - Fax:708-216-5617
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360909022084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36090902Medicaid
IL36090902Medicaid
IL203649Medicare ID - Type Unspecified