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

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 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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