Provider Demographics
NPI:1992734446
Name:SCHOENWALD, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:SCHOENWALD
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 1:621 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5077
Mailing Address - Country:US
Mailing Address - Phone:815-397-3350
Mailing Address - Fax:815-227-2992
Practice Address - Street 1:621 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5077
Practice Address - Country:US
Practice Address - Phone:815-397-3350
Practice Address - Fax:815-227-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37283Medicare UPIN
IL834370Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILCC5050Medicare ID - Type UnspecifiedRR GROUP #
ILL92982Medicare ID - Type Unspecified
ILL36981Medicare ID - Type Unspecified