Provider Demographics
NPI:1811980303
Name:SCHAEFER, KIMBERLY P (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:P
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3109
Mailing Address - Country:US
Mailing Address - Phone:847-433-3460
Mailing Address - Fax:847-433-4062
Practice Address - Street 1:1777 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3109
Practice Address - Country:US
Practice Address - Phone:847-433-3460
Practice Address - Fax:847-433-4062
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00148713OtherRR MEDICARE
IL036109784Medicaid
I15159Medicare UPIN
ILK09310Medicare PIN