Basic Information
Provider Information | |||||||||
NPI: | 1871507954 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHLUETER | ||||||||
FirstName: | JEFFREY | ||||||||
MiddleName: | ALAN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10 4TH AVE SE | ||||||||
Address2: |   | ||||||||
City: | GLENWOOD | ||||||||
State: | MN | ||||||||
PostalCode: | 563341820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3206344521 | ||||||||
FaxNumber: | 3206342262 | ||||||||
Practice Location | |||||||||
Address1: | 10 4TH AVE SE | ||||||||
Address2: |   | ||||||||
City: | GLENWOOD | ||||||||
State: | MN | ||||||||
PostalCode: | 563341820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3206344521 | ||||||||
FaxNumber: | 3206342262 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 23363 | MN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 49339SC | 01 | MN | BLUE CROSS | OTHER | 4T8985C | 01 | MN | BLUE CROSS | OTHER | 01-07698 | 01 |   | MEDICA | OTHER | 01-08144 | 01 |   | MEDICA | OTHER | FP0958 | 01 |   | ARAZ | OTHER | 1004386 | 01 |   | PREFERRED ONE | OTHER | 110888 | 01 |   | UCARE | OTHER | 01-06780 | 01 |   | MEDICA | OTHER | 39-40029 | 01 |   | MEDICA | OTHER | HP25514 | 01 |   | HEALTH PARTNERS | OTHER |