Provider Demographics
NPI:1154367340
Name:SCHWIETERMAN, STEVEN CARL (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CARL
Last Name:SCHWIETERMAN
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 1:750 BROADWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1411
Mailing Address - Country:US
Mailing Address - Phone:260-423-2682
Mailing Address - Fax:260-422-4326
Practice Address - Street 1:750 BROADWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1411
Practice Address - Country:US
Practice Address - Phone:260-423-2682
Practice Address - Fax:260-422-4326
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047129A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200102510Medicaid
000000206216OtherBLUE CROSS
IN185760EMedicare ID - Type Unspecified
000000206216OtherBLUE CROSS