Provider Demographics
NPI:1871675462
Name:SAWYER, RENATA A (MD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:A
Last Name:SAWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENATA
Other - Middle Name:A
Other - Last Name:WILCZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:SUITE 4410
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-647-1650
Practice Address - Fax:574-647-1655
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062407207V00000X
IN01062407A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN181980003OtherMEDICARE PTAN
IN200843760Medicaid