Provider Demographics
NPI:1891739082
Name:SCHMIDT, SUZANNE MARIE (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:SZCZEPANIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2035 W WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:773-880-8245
Mailing Address - Fax:773-880-8267
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:312-573-4512
Practice Address - Fax:312-573-8400
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0204X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
36447021402OtherTRICARE