Provider Demographics
NPI:1417938572
Name:SCHWIETERS, MARY C (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:SCHWIETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1043
Mailing Address - Country:US
Mailing Address - Phone:320-256-4228
Mailing Address - Fax:320-256-7106
Practice Address - Street 1:525 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1043
Practice Address - Country:US
Practice Address - Phone:320-256-4228
Practice Address - Fax:320-256-7106
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
64D17SCOtherBLUE CROSS BLUE SHIELD
123380OtherUCARE
316722400OtherMEDICAL ASSISTANCE
839396OtherARAZ GROUP AMERICAS PPO
0116239OtherMEDICA HEALTH PLANS
1019738OtherPREFERRED ONE
2113972OtherFIRST HEALTH PLAN
HP29093OtherHEALTH PARTNERS
2113972OtherFIRST HEALTH PLAN
1019738OtherPREFERRED ONE