Provider Demographics
NPI:1073518957
Name:SCHLICHTEMEIER, TAMMI LYN (MD)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:LYN
Last Name:SCHLICHTEMEIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9606
Mailing Address - Country:US
Mailing Address - Phone:972-393-8687
Mailing Address - Fax:972-393-4975
Practice Address - Street 1:1705 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-9606
Practice Address - Country:US
Practice Address - Phone:972-393-8687
Practice Address - Fax:972-393-4975
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046127901Medicaid
TX046127901Medicaid
TXF56182Medicare UPIN