1184629677 NPI number — MRS. BIRUTE BALCIUNAS SCHLECHT D.P.M.

Table of content: MRS. BIRUTE BALCIUNAS SCHLECHT D.P.M. (NPI 1184629677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184629677 NPI number — MRS. BIRUTE BALCIUNAS SCHLECHT D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLECHT
Provider First Name:
BIRUTE
Provider Middle Name:
BALCIUNAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALCIUNAS
Provider Other First Name:
BIRUTE
Provider Other Middle Name:
ZITA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184629677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 35TH ST
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53140-5119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-652-6555
Provider Business Mailing Address Fax Number:
262-652-7414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 35TH ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53140-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-652-6555
Provider Business Practice Location Address Fax Number:
262-652-7414
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  711-025 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 016-004620 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43221800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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