Provider Demographics
NPI:1114285947
Name:SCHOWENGERDT, SAMUEL WIELAND (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WIELAND
Last Name:SCHOWENGERDT
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 1:5330 N OAK TRFY STE 102
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4600
Mailing Address - Country:US
Mailing Address - Phone:816-478-4887
Mailing Address - Fax:816-478-7140
Practice Address - Street 1:5330 N OAK TRFY STE 102
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118
Practice Address - Country:US
Practice Address - Phone:816-478-4887
Practice Address - Fax:816-478-7140
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016012568207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology