1003875808 NPI number — JOHN M SCHRUEFER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003875808 NPI number — JOHN M SCHRUEFER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRUEFER
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHRUEFER
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003875808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BUTTERFIELD RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-725-2730
Provider Business Mailing Address Fax Number:
844-205-5691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9420 KEY WEST AVE
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-725-2730
Provider Business Practice Location Address Fax Number:
844-205-5691
Provider Enumeration Date:
03/21/2006

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: 202K00000X , with the licence number:  D0065238 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 0101238887 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 0101238887 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540490687003 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010201942 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003875808 . This is a "NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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