Provider Demographics
NPI:1790743029
Name:SCHWENT, JOHN T (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:SCHWENT
Suffix:
Gender:M
Credentials:DO
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 4853
Mailing Address - Street 2:DEPT 4036 MIDWEST EMERGENCY ASSOCIATES - DEPAUL LLC
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522
Mailing Address - Country:US
Mailing Address - Phone:636-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:12303 DEPAUL DRIVE
Practice Address - Street 2:DEPAUL HEALTH CENTER
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-6000
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6301207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240691949Medicaid
MO240691949Medicaid
MO909443849Medicare ID - Type Unspecified
MO132110003Medicare PIN
MO132100007Medicare PIN