Provider Demographics
NPI:1720354699
Name:SCHUTZ, CHARLES E (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:SCHUTZ
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 1:3260 N LAKE SHORE DR
Mailing Address - Street 2:APT 7B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3955
Mailing Address - Country:US
Mailing Address - Phone:773-525-3129
Mailing Address - Fax:773-525-3129
Practice Address - Street 1:3260 N LAKE SHORE DR
Practice Address - Street 2:APT 7B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3955
Practice Address - Country:US
Practice Address - Phone:773-525-3129
Practice Address - Fax:773-525-3129
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics