Individual
KURT J SCHLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-7627
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01030409A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185068
ANTHEM PROVIDER NUMBER
IN
05
—
100078490
—
IN
01
—
10825896
CAQH NUMBER
IN
01
—
9397458
PHCS PID NUMBER
IN
05
—
SC12875001
—
IN
Enumeration date
03/21/2006
Last updated
07/23/2012
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