Provider Demographics
NPI:1891757290
Name:SCHNEEKLOTH, KATHLEEN LYNNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LYNNE
Last Name:SCHNEEKLOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1000 E 23RD ST
Practice Address - Street 2:STE 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2114
Practice Address - Country:US
Practice Address - Phone:605-322-1625
Practice Address - Fax:605-322-1626
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD49792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7200674Medicaid
SD7200670Medicaid
F27797Medicare UPIN
SD7200674Medicaid
SD7200670Medicaid