Healthcare Provider Details

I. General information

NPI: 1053998542
Provider Name (Legal Business Name): VAN AMBROSE SCHLOEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N KEENE ST STE 201
COLUMBIA MO
65201-8131
US

IV. Provider business mailing address

105 N KEENE ST STE 201
COLUMBIA MO
65201-8131
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-4990
  • Fax: 573-442-2120
Mailing address:
  • Phone: 573-499-4990
  • Fax: 573-442-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2026021922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: