Provider Demographics
NPI:1447713409
Name:SCHENCK, JEFFREY MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:SCHENCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LUDWIG DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1332
Mailing Address - Country:US
Mailing Address - Phone:618-397-9000
Mailing Address - Fax:618-397-9003
Practice Address - Street 1:5 LUDWIG DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1332
Practice Address - Country:US
Practice Address - Phone:618-397-9000
Practice Address - Fax:618-397-9003
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036157832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine