Provider Demographics
NPI:1932104296
Name:SCHWARM, BRENT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WAYNE
Last Name:SCHWARM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1227
Mailing Address - Country:US
Mailing Address - Phone:618-283-1231
Mailing Address - Fax:
Practice Address - Street 1:650 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1227
Practice Address - Country:US
Practice Address - Phone:618-283-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086476Medicaid
IL036086476Medicaid
IL148938Medicare ID - Type UnspecifiedALTAMONT, IL MED #
IL036086476Medicaid
ILF60218Medicare UPIN
IL143928Medicare ID - Type UnspecifiedST. ELMO, IL MED #