Provider Demographics
NPI:1194794222
Name:SCHWARTZ, HAROLD S (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:S
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 1:6601 N AVONDALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1572
Mailing Address - Country:US
Mailing Address - Phone:773-792-1011
Mailing Address - Fax:773-889-0224
Practice Address - Street 1:6601 N AVONDALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1572
Practice Address - Country:US
Practice Address - Phone:773-792-1011
Practice Address - Fax:773-889-0224
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622244OtherBCBS
IL036055220Medicaid
L83074Medicare PIN
180034465Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL036055220Medicaid