Provider Demographics
NPI:1528128634
Name:SCHULDT PERFORMANCE CENTER
Entity type:Organization
Organization Name:SCHULDT PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-579-1357
Mailing Address - Street 1:636 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4361
Mailing Address - Country:US
Mailing Address - Phone:847-579-1357
Mailing Address - Fax:847-579-1359
Practice Address - Street 1:636 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4361
Practice Address - Country:US
Practice Address - Phone:847-579-1357
Practice Address - Fax:847-579-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04922184OtherBCBS