Provider Demographics
NPI:1740288307
Name:SCHLIEVERT, RANDALL S (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:SCHLIEVERT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7146
Mailing Address - Fax:419-383-2050
Practice Address - Street 1:3120 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5811
Practice Address - Country:US
Practice Address - Phone:419-383-3771
Practice Address - Fax:419-383-3162
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079000208000000X
OH35.0790002080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2259998Medicaid
OH2259998Medicaid
H59311Medicare UPIN