Provider Demographics
NPI:1528164076
Name:SCHAIBLE, KEITH L (MD)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:SCHAIBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3317 W 95TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2243
Mailing Address - Country:US
Mailing Address - Phone:708-423-5402
Mailing Address - Fax:708-423-5733
Practice Address - Street 1:3317 W 95TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2243
Practice Address - Country:US
Practice Address - Phone:708-423-5402
Practice Address - Fax:708-423-5733
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31604320OtherBC/BS
IL31604320OtherBC/BS
IL980320Medicare ID - Type Unspecified