Provider Demographics
NPI:1861423659
Name:JAMES L SCHUTZENHOFER MD LLC
Entity type:Organization
Organization Name:JAMES L SCHUTZENHOFER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SCHUTZENHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-545-1705
Mailing Address - Street 1:1050 MARTIN LUTHER KING DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-545-1705
Mailing Address - Fax:618-545-1703
Practice Address - Street 1:1050 MARTIN LUTHER KING DRIVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-545-1705
Practice Address - Fax:618-545-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06132002OtherBLUE SHIELD
IL211167Medicare ID - Type UnspecifiedMEDICARE