Provider Demographics
NPI:1780689810
Name:SCHWARTZ, CRAIG I (DO, FACOS, FICS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:I
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DO, FACOS, FICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 104TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4561
Mailing Address - Country:US
Mailing Address - Phone:913-451-8346
Mailing Address - Fax:913-451-8347
Practice Address - Street 1:1300 E 104TH ST
Practice Address - Street 2:STE 150
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4561
Practice Address - Country:US
Practice Address - Phone:913-451-8346
Practice Address - Fax:913-451-8347
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030126572086S0129X
KS05-301312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-30131OtherKS STATE LICENSE #
KS32801024OtherBC/BS OF K.C. PROVIDER #
Q56C896Medicare ID - Type Unspecified
KS32801024OtherBC/BS OF K.C. PROVIDER #