Provider Demographics
NPI:1891754313
Name:SCHLEIFER, KIETH R (MD)
Entity Type:Individual
Prefix:
First Name:KIETH
Middle Name:R
Last Name:SCHLEIFER
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:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0578
Mailing Address - Country:US
Mailing Address - Phone:719-767-5661
Mailing Address - Fax:
Practice Address - Street 1:615 W 5TH ST N
Practice Address - Street 2:
Practice Address - City:CHEYENNE WELLS
Practice Address - State:CO
Practice Address - Zip Code:80810
Practice Address - Country:US
Practice Address - Phone:719-767-5669
Practice Address - Fax:719-767-5098
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17751207P00000X
CODR.0028051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3027661Medicaid
TN4124004OtherBCBS
TN4124004OtherBCBS
A99153Medicare UPIN