Healthcare Provider Details

I. General information

NPI: 1003875808
Provider Name (Legal Business Name): JOHN M SCHRUEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN SCHRUEFER MD

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 KEY WEST AVE #204
ROCKVILLE MD
20850-3334
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 300
DOWNERS GROVE IL
60515-1069
US

V. Phone/Fax

Practice location:
  • Phone: 630-725-2730
  • Fax: 844-205-5691
Mailing address:
  • Phone: 630-725-2730
  • Fax: 844-205-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101238887
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101238887
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberD0065238
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: