Provider Demographics
NPI: | 1013914720 |
---|---|
Name: | SCHWARTZ, KERRY M (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | KERRY |
Middle Name: | M |
Last Name: | SCHWARTZ |
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: | 1613 N MILLS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32803-1849 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 407-894-4474 |
Mailing Address - Fax: | 407-894-7136 |
Practice Address - Street 1: | 1613 N MILLS AVE |
Practice Address - Street 2: | |
Practice Address - City: | ORLANDO |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32803-1849 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-894-4474 |
Practice Address - Fax: | 407-894-7136 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-07 |
Last Update Date: | 2010-07-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME0036337 | 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 2659048 | Other | CIGNA |
FL | 4008556 | Other | AETNA |
FL | 11581 | Other | FHHS |
FL | 212319 | Other | AVMED |
FL | 47355 | Other | BCBS |
FL | 060019791 | Other | RRR |
FL | 11581 | Other | FHHS |
D55022 | Medicare UPIN |