1659571966 NPI number — SHELDON FLEISHMAN D.P.M., P.A.

Table of content: (NPI 1659571966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659571966 NPI number — SHELDON FLEISHMAN D.P.M., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELDON FLEISHMAN D.P.M., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659571966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 S OUTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64015-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-228-9393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10701 NALL AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-381-5515
Provider Business Practice Location Address Fax Number:
913-381-5514
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLEISHMAN
Authorized Official First Name:
SHELDON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-381-5515

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  12-00109 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00337630 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 07902022 . This is a "KANSAS CITY BLUE CROSS BL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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