Provider Demographics
NPI: | 1356585590 |
---|---|
Name: | SCHLEIFER, JOHN WILLIAM (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | JOHN |
Middle Name: | WILLIAM |
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: | 988102 NEBRASKA MEDICAL CTR |
Mailing Address - Street 2: | |
Mailing Address - City: | OMAHA |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68198-8102 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | EMILE AT 42ND ST |
Practice Address - Street 2: | |
Practice Address - City: | OMAHA |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68198-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-559-8888 |
Practice Address - Fax: | 402-559-3060 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-04-30 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 29861 | 207RC0001X |
MN | 59015 | 207RC0001X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 720052 | Medicaid | |
AZ | Z92848 | Medicare PIN |