Provider Demographics
NPI:1437338100
Name:MICHAEL SHWAYDER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL SHWAYDER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W T
Authorized Official - Last Name:SHWAYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-301-0015
Mailing Address - Street 1:6801 PARK TERRACE DR
Mailing Address - Street 2:SUITE 530B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1543
Mailing Address - Country:US
Mailing Address - Phone:310-301-0015
Mailing Address - Fax:310-301-4882
Practice Address - Street 1:6801 PARK TERRACE DR
Practice Address - Street 2:SUITE 530B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1543
Practice Address - Country:US
Practice Address - Phone:310-301-0015
Practice Address - Fax:310-301-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW14324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14324OtherGROUP MEDICARE NUMBER