Provider Demographics
NPI:1942382452
Name:SCHLEISS, MARK RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:SCHLEISS
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 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0590810Medicaid
MN92-00185OtherMEDICA CHOICE
MNHP49830OtherHEALTH PARTNERS
MN2327064OtherARAZ
MN92-12094OtherMEDICA PRIMARY
WI34522000Medicaid
MN2327061OtherARAZ/PPO
MN132663OtherUCARE
MN1043104OtherPREFERRED ONE
MN847935600Medicaid
E72411Medicare UPIN
IA0590810Medicaid