Provider Demographics
NPI:1780646984
Name:SCHOENEWE, COREY SHAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:SHAWN
Last Name:SCHOENEWE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9912 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1620
Mailing Address - Country:US
Mailing Address - Phone:918-622-0641
Mailing Address - Fax:918-622-4814
Practice Address - Street 1:9912 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1620
Practice Address - Country:US
Practice Address - Phone:918-622-0641
Practice Address - Fax:918-622-4814
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1275528085OtherHEALTH CHOICE
OK1275528085OtherCIGNA
OK100113790AMedicaid
OK1275528085OtherHUMANA CHOICE POS
OK1275528085OtherBLUE CROSS BLUE SHIELD
OK1275528085OtherHEALTH CHOICE