Provider Demographics
NPI:1144252552
Name:SCHWARTZMAN, ILYA (MD)
Entity type:Individual
Prefix:MR
First Name:ILYA
Middle Name:
Last Name:SCHWARTZMAN
Suffix:
Gender:M
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:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:3581 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2036
Practice Address - Country:US
Practice Address - Phone:812-376-9601
Practice Address - Fax:812-378-8518
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037683A207Q00000X
IN01037683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
003944OtherSIHO
IN100083410AMedicaid
IN000000089434OtherANTHEM
IN000000990927OtherANTHEM PIN
IN100083410Medicaid
IN351896225100OtherCARESOURCE
351896225OtherCOMMERCIAL
IN100083410AMedicaid
351896225OtherCOMMERCIAL
IN351896225100OtherCARESOURCE