1366403156 NPI number — DR. CLARK FRIEDRICH SCHIERLE MD, PHD, FACS

Table of content: DR. CLARK FRIEDRICH SCHIERLE MD, PHD, FACS (NPI 1366403156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366403156 NPI number — DR. CLARK FRIEDRICH SCHIERLE MD, PHD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHIERLE
Provider First Name:
CLARK
Provider Middle Name:
FRIEDRICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD, FACS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366403156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
676 N SAINT CLAIR ST
Provider Second Line Business Mailing Address:
SUITE 1575
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-266-6240
Provider Business Mailing Address Fax Number:
312-266-1411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
676 N SAINT CLAIR ST
Provider Second Line Business Practice Location Address:
SUITE 1525A
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-266-6240
Provider Business Practice Location Address Fax Number:
312-266-1411
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  125046394 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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