Provider Demographics
NPI:1609901354
Name:SCHWENCK, GEORGE (DPM PA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:SCHWENCK
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 NE 108TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7427
Mailing Address - Country:US
Mailing Address - Phone:305-505-1873
Mailing Address - Fax:877-289-0103
Practice Address - Street 1:17751 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3924
Practice Address - Country:US
Practice Address - Phone:954-251-1687
Practice Address - Fax:877-289-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0001896213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001454100Medicaid
FL65023Medicare PIN
FLT85369Medicare UPIN
FL001454100Medicaid