Provider Demographics
NPI:1679561880
Name:SCHWIRTLICH, LONNIE R (MD)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:R
Last Name:SCHWIRTLICH
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:PO BOX 60112
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0112
Mailing Address - Country:US
Mailing Address - Phone:361-949-0204
Mailing Address - Fax:361-857-0572
Practice Address - Street 1:14254 SPID DR STE 207
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6278
Practice Address - Country:US
Practice Address - Phone:361-589-4068
Practice Address - Fax:361-589-4079
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7376207P00000X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P5514OtherBCBS PROV. NO.
TX138465313Medicaid
TXP00209463OtherRAILROAD MCARE PROV. NO.
TX8C6119Medicare ID - Type UnspecifiedPROVIDER NO.