Provider Demographics
NPI:1114914264
Name:SCHWIETERMAN, THOMAS D (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
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 1:8381 STATE ROUTE 119
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-9701
Mailing Address - Country:US
Mailing Address - Phone:419-925-4613
Mailing Address - Fax:419-925-4168
Practice Address - Street 1:8381 STATE ROUTE 119
Practice Address - Street 2:
Practice Address - City:MARIA STEIN
Practice Address - State:OH
Practice Address - Zip Code:45860-9701
Practice Address - Country:US
Practice Address - Phone:419-925-4613
Practice Address - Fax:419-925-4168
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-8272-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141055Medicaid
OH0141055Medicaid
OHSC0779601Medicare ID - Type Unspecified