Healthcare Provider Details

I. General information

NPI: 1083694137
Provider Name (Legal Business Name): JOHN E SCHILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE SUITE 101
COLORADO SPRINGS CO
80907-6831
US

IV. Provider business mailing address

1425 N UNION BLVD SUITE 202
COLORADO SPRINGS CO
80909-2871
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5281
  • Fax: 719-471-9314
Mailing address:
  • Phone: 719-570-7675
  • Fax: 719-471-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number17903
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: