Provider Demographics
NPI:1780182907
Name:JEFFREY SCHWALB DPM PLLC
Entity Type:Organization
Organization Name:JEFFREY SCHWALB DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWALB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-626-7180
Mailing Address - Street 1:5755 W MAPLE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4415
Mailing Address - Country:US
Mailing Address - Phone:248-626-7180
Mailing Address - Fax:
Practice Address - Street 1:5755 W MAPLE RD STE 115
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4415
Practice Address - Country:US
Practice Address - Phone:248-626-7180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS001177213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty