Provider Demographics
NPI:1184611394
Name:SCHWIETERMAN, JAMES T (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:SCHWIETERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 S KNOXVILLE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2609
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:8381 STATE ROUTE 119
Practice Address - Street 2:
Practice Address - City:MARIA STEIN
Practice Address - State:OH
Practice Address - Zip Code:45860-9701
Practice Address - Country:US
Practice Address - Phone:419-925-4613
Practice Address - Fax:419-925-4168
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9399-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0838571Medicaid
OHSC0698461Medicare ID - Type Unspecified
OHE95883Medicare UPIN