Provider Demographics
NPI:1922299585
Name:SCHWIED, ELLIS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ELLIS
Middle Name:MICHAEL
Last Name:SCHWIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30100 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE O-307
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-0000
Mailing Address - Country:US
Mailing Address - Phone:949-466-4692
Mailing Address - Fax:949-707-5314
Practice Address - Street 1:24800 CHRISANTA DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4838
Practice Address - Country:US
Practice Address - Phone:949-707-1416
Practice Address - Fax:949-707-5314
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA392452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry