MEDICARE: SHELDON FLEISHMAN DPM, PA

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	213ES0131X	Foot Surgery Podiatrist	000356	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4759940002	OTHER	MO	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	07902022	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790991172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELDON FLEISHMAN DPM, PA

Provider Business Mailing Address
First Line	:	1050 NW SOUTH OUTER RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3064
Country	:	US
Telephone Number	:	816-228-9393
Fax Number	:	816-228-5462

Provider Business Practice Location Address
First Line	:	1050 NW SOUTH OUTER RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3064
Country	:	US
Telephone Number	:	816-228-9393
Fax Number	:	816-228-5462

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHELDON FLEISHMAN
Credential	:	DPM
Telephone Number	:	816-228-9393

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	10/31/2007

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