Provider Demographics
NPI:1003875808
Name:SCHRUEFER, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SCHRUEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SCHRUEFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1069
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:9420 KEY WEST AVE
Practice Address - Street 2:#204
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3334
Practice Address - Country:US
Practice Address - Phone:630-725-2730
Practice Address - Fax:844-205-5691
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065238202K00000X
VA0101238887207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540490687003OtherTRICARE
VA010201942Medicaid
VA1003875808OtherNPI
VAP00620363Medicare PIN
VA1003875808OtherNPI
VAG15333Medicare UPIN
MD339LS873Medicare PIN
VA010201942Medicaid
VADG0518Medicare PIN
VA008742S48Medicare ID - Type Unspecified