Provider Demographics
NPI:1962410589
Name:SCHWALB, JEFFREY (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SCHWALB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21647 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091
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
Practice Address - Country:US
Practice Address - Phone:586-754-7777
Practice Address - Fax:586-754-7781
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1177213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4423462Medicaid
T34161Medicare UPIN
MI1179760001Medicare NSC
MI4423462Medicaid