Provider Demographics
NPI:1700838562
Name:SCHWARTZ, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
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 1:1121 LAKE COOK RD
Mailing Address - Street 2:STE M
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5234
Mailing Address - Country:US
Mailing Address - Phone:847-945-4550
Mailing Address - Fax:847-948-8103
Practice Address - Street 1:1416C S RANDALL RD
Practice Address - Street 2:RANDALL SQUAR SHOPPING CENTER
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4682
Practice Address - Country:US
Practice Address - Phone:630-208-9325
Practice Address - Fax:630-208-9326
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360425282085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042528Medicaid
ILL05026Medicare ID - Type Unspecified
IL036042528Medicaid
ILK07631Medicare ID - Type Unspecified