Provider Demographics
NPI:1366493397
Name:SCHWIESOW, TYLER M (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:M
Last Name:SCHWIESOW
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 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-8221
Mailing Address - Fax:
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0486191Medicaid
IA1366493397Medicaid
IA1486191Medicaid
IAP00336738OtherRR MEDICARE
IA0486191Medicaid