Provider Demographics
NPI:1538625629
Name:JEFFREY SCHWALB
Entity type:Organization
Organization Name:JEFFREY SCHWALB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWALB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-754-7777
Mailing Address - Street 1:21647 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2795
Mailing Address - Country:US
Mailing Address - Phone:586-754-7777
Mailing Address - Fax:586-754-7781
Practice Address - Street 1:21647 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2795
Practice Address - Country:US
Practice Address - Phone:586-754-7777
Practice Address - Fax:586-754-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty