Provider Demographics
NPI:1477533503
Name:SCHWAB, CHARLES F (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 N OAK TRFY
Mailing Address - Street 2:#100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2256
Mailing Address - Country:US
Mailing Address - Phone:816-455-0661
Mailing Address - Fax:816-455-3905
Practice Address - Street 1:9501 N OAK TRFY
Practice Address - Street 2:#100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2256
Practice Address - Country:US
Practice Address - Phone:816-455-0661
Practice Address - Fax:816-455-3905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO318582085R0202X
KS143632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS025474OtherBCBS OF KANSAS
MO05559070OtherBCBS OF KANSAS CITY
MO2262035OtherAETNA
MOC51543Medicare UPIN
MO3372463Medicare ID - Type Unspecified