Healthcare Provider Details

I. General information

NPI: 1790873016
Provider Name (Legal Business Name): DAVID J SCHLEICHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 N ALPINE RD
ROCKFORD IL
61107-2201
US

IV. Provider business mailing address

PO BOX 78866
MILWAUKEE WI
53278-8866
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-9201
  • Fax:
Mailing address:
  • Phone: 779-696-7150
  • Fax: 779-696-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036-083186
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036083186
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: