Provider Demographics
NPI:1265411516
Name:SCHWARTZ, SUSAN E (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N RAMPART BLVD STE 187
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7640
Mailing Address - Country:US
Mailing Address - Phone:702-647-2900
Mailing Address - Fax:702-440-6060
Practice Address - Street 1:8985 S PECOS RD STE 3B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7163
Practice Address - Country:US
Practice Address - Phone:702-647-2900
Practice Address - Fax:702-440-6060
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011091207YX0905X
NV1301207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510939Medicaid
NV100510939Medicaid
NV103830Medicare PIN