MEDICARE: DR. RANDALL S SCHLIEVERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35079000	OH
2	2080C0008X	Child Abuse Pediatrics Physician	35.079000	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740288307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL S SCHLIEVERT M.D.

Provider Business Mailing Address
First Line	:	3355 GLENDALE AVE
Second Line	:	3RD FLOOR
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-7146
Fax Number	:	419-383-2050

Provider Business Practice Location Address
First Line	:	3120 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-5811
Country	:	US
Telephone Number	:	419-383-3771
Fax Number	:	419-383-3162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/09/2025

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