Provider Demographics
NPI:1235117490
Name:SCHWANK, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:SCHWANK
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 1:165 NATCHEZ TRACE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7940
Mailing Address - Country:US
Mailing Address - Phone:270-782-7800
Mailing Address - Fax:270-843-0779
Practice Address - Street 1:165 NATCHEZ TRACE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7940
Practice Address - Country:US
Practice Address - Phone:270-782-7800
Practice Address - Fax:270-843-0779
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000573948OtherANTHEM
KY163580300OtherDEPARTMENT OF LABOR
KY64187966Medicaid
KYD82712Medicare UPIN
KY163580300OtherDEPARTMENT OF LABOR