Provider Demographics
NPI:1588631238
Name:SCHOENWALDER, MICHAEL S (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SCHOENWALDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15945 CLAYTON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2490
Mailing Address - Country:US
Mailing Address - Phone:636-256-5350
Mailing Address - Fax:636-256-5372
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:636-256-5350
Practice Address - Fax:636-256-5372
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003014482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I29717Medicare UPIN