Provider Demographics
NPI:1942474341
Name:STEVEN M SCHWIMMER, D.O.
Entity Type:Organization
Organization Name:STEVEN M SCHWIMMER, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIARECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-655-6742
Mailing Address - Street 1:9875 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8895
Mailing Address - Country:US
Mailing Address - Phone:414-485-2206
Mailing Address - Fax:414-858-2236
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-654-2500
Practice Address - Fax:262-654-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28193-021207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB56470Medicare UPIN
WI5454580001Medicare NSC