Provider Demographics
NPI:1164441101
Name:DAVID SCHWINDT LLC
Entity Type:Organization
Organization Name:DAVID SCHWINDT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWINDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:8605-720-0010
Mailing Address - Street 1:23 CLARA DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:860-572-0010
Mailing Address - Fax:860-536-2799
Practice Address - Street 1:23 CLARA DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-572-0010
Practice Address - Fax:860-536-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0471821207RA0000X
RIMD11245207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28906Medicare UPIN