Provider Demographics
NPI:1104937044
Name:SCHWARTZ, STEPHEN L (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:SCHWARTZ
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3130
Mailing Address - Fax:812-242-3596
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3130
Practice Address - Fax:812-242-3596
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045244A208800000X
IL36094330208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200106500PMedicaid
IN200106500ZMedicaid
ILP00866712OtherRAILROAD MEDICARE
IN200106500Medicaid
000000089637OtherANTHEM
340016673OtherRAILROAD MCARE PALAMETTO
340011973OtherRAILROAD MCARE PALAMETTO
INP00818724OtherRAILROAD MEDICARE
G33360Medicare UPIN
IN265130UUUMedicare PIN
340011973OtherRAILROAD MCARE PALAMETTO
INP00818724OtherRAILROAD MEDICARE
ILP00866712OtherRAILROAD MEDICARE
IN200106500ZMedicaid
IN859910ZZMedicare PIN