Provider Demographics
NPI:1386851822
Name:GEORGE SCHWENCK DPM PA
Entity Type:Organization
Organization Name:GEORGE SCHWENCK DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWENCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-505-1873
Mailing Address - Street 1:1584 NE 108TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7427
Mailing Address - Country:US
Mailing Address - Phone:305-595-3005
Mailing Address - Fax:305-595-3360
Practice Address - Street 1:17751 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3924
Practice Address - Country:US
Practice Address - Phone:954-251-1687
Practice Address - Fax:954-613-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1896213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001454100Medicaid
FLT85369Medicare UPIN
FL6319630001Medicare NSC
FL001454100Medicaid