Provider Demographics
NPI:1649380429
Name:SCHWARTZ, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:SCHWARTZ
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 1:696 HAMPSHIRE ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-449-7204
Mailing Address - Fax:805-830-0436
Practice Address - Street 1:696 HAMPSHIRE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-449-7204
Practice Address - Fax:805-830-0436
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45500208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45500OtherLICENSE
CAA45500OtherLICENSE
G27367Medicare UPIN