Provider Demographics
NPI:1578526703
Name:SCHWARTZ, RICHARD SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAUL
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2087
Mailing Address - Country:US
Mailing Address - Phone:248-625-1123
Mailing Address - Fax:248-625-7044
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 304
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-625-1123
Practice Address - Fax:248-625-7044
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIME4301035318207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0630751Medicare ID - Type Unspecified
MIB47095Medicare UPIN