Provider Demographics
NPI:1063501922
Name:SCHWENK, THOMAS L (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:SCHWENK
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 1:401 WEST 2ND STREET
Mailing Address - Street 2:NELSON/227/MAIL STOP 353
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-784-1223
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:123 17TH STREET, MAIL STOP 316
Practice Address - Street 2:BRIGHAM BUILDING
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557
Practice Address - Country:US
Practice Address - Phone:775-784-1533
Practice Address - Fax:775-784-8075
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047795207Q00000X, 207QS0010X
NV14002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1641600Medicaid
MI0H17630003Medicare ID - Type Unspecified
MI1641600Medicaid
B48511Medicare UPIN