Basic Information
Provider Information
NPI: 1497868343
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHLESINGER
FirstName: DANIEL
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3691 RUTGER AVE
Address2:  
City: ST. LOUIS
State: MO
PostalCode: 63110
CountryCode: US
TelephoneNumber: 3149776828
FaxNumber: 3149776777
Practice Location
Address1: 1465 S GRAND BLVD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631041003
CountryCode: US
TelephoneNumber: 3145775360
FaxNumber: 3142684116
Other Information
ProviderEnumerationDate: 08/16/2006
LastUpdateDate: 07/16/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X2006017174MON Allopathic & Osteopathic PhysiciansPediatrics 
2080P0204X2006017174MOY Allopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine

No ID Information.


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