Provider Demographics
NPI:1053998542
Name:SCHLOEGEL, VAN AMBROSE
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:AMBROSE
Last Name:SCHLOEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET
Mailing Address - Street 2:ROOM MN 283
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-323-5057
Mailing Address - Fax:859-257-6024
Practice Address - Street 1:800 ROSE STREET
Practice Address - Street 2:ROOM MN 283
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-5057
Practice Address - Fax:859-257-6024
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program