Provider Demographics
NPI:1609869791
Name:SCHWISOW, ALLEN G (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:G
Last Name:SCHWISOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6588
Mailing Address - Country:US
Mailing Address - Phone:419-893-3306
Mailing Address - Fax:419-893-2274
Practice Address - Street 1:5600 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1800
Practice Address - Country:US
Practice Address - Phone:419-893-3306
Practice Address - Fax:419-893-2274
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0453594Medicaid
OH0453594Medicaid