Provider Demographics
NPI:1487649562
Name:SCHWARTZ, STACEY BETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BETH
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32255 NORTHWESTERN HWY STE 195
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1566
Mailing Address - Country:US
Mailing Address - Phone:248-419-3550
Mailing Address - Fax:248-419-3547
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 195
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1566
Practice Address - Country:US
Practice Address - Phone:248-894-3785
Practice Address - Fax:248-419-3547
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001867213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4508677Medicaid
MI4508677Medicaid
MIOF36279004Medicare ID - Type Unspecified