Basic Information
| Provider Information | |||||||||
| NPI: | 1811013576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | BRANT | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 W 75TH ST | ||||||||
| Address2: | STE 140 | ||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137225551 | ||||||||
| FaxNumber: | 9133620583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 5101016672 | MI | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 33069 | KS | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 2008004467 | MO | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | P00625374 | 01 | KS | RAILROAD MEDICARE | OTHER |