Provider Demographics
NPI:1306855325
Name:SCHLEINKOFER, ROBERT MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MELVIN
Last Name:SCHLEINKOFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:3217 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5427
Practice Address - Country:US
Practice Address - Phone:260-422-8591
Practice Address - Fax:260-423-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020184A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052930AMedicaid
IN000000651033OtherANTHEM
INP00867159OtherMEDICARE RR
055110Medicare ID - Type Unspecified
IN259060DDMedicare PIN
B28112Medicare UPIN