Provider Demographics
NPI:1124007539
Name:SCHWARTZENFELD, TED H (DO)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:H
Last Name:SCHWARTZENFELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27483 DEQUINDRE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5711
Mailing Address - Country:US
Mailing Address - Phone:248-541-0100
Mailing Address - Fax:248-399-3960
Practice Address - Street 1:27483 DEQUINDRE RD STE 201
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5711
Practice Address - Country:US
Practice Address - Phone:248-541-0100
Practice Address - Fax:248-399-3960
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006332207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4170644Medicaid
MI4170653Medicaid
MI4170662Medicaid
MI4343620Medicaid
MIP13760004Medicare ID - Type Unspecified
MI4170662Medicaid