Provider Demographics
NPI:1235272402
Name:SCHWALENBERG, EVELYN A (DO)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:A
Last Name:SCHWALENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:SCHWALENBERG-LEIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-0787
Mailing Address - Country:US
Mailing Address - Phone:508-612-5520
Mailing Address - Fax:
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:SANFORD L. ZIFF BLDG.
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-4100
Practice Address - Fax:954-262-2271
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1692207R00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33295Medicare UPIN