Basic Information
Provider Information | |||||||||
NPI: | 1386797330 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHELZIG | ||||||||
FirstName: | COLLEEN | ||||||||
MiddleName: | CAMPBELL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CAMPBELL | ||||||||
OtherFirstName: | COLLEEN | ||||||||
OtherMiddleName: | MCGEE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 9500 EUCLID AVE | ||||||||
Address2: | MAIL CODE HC23 | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441950001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2164444998 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6780 MAYFIELD RD | ||||||||
Address2: |   | ||||||||
City: | MAYFIELD HEIGHTS | ||||||||
State: | OH | ||||||||
PostalCode: | 441242203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2164444998 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/20/2007 | ||||||||
LastUpdateDate: | 07/20/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0116016849 | VA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | M-1553 | GU | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | A110504 | CA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 35.096654 | OH | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.