Provider Demographics
NPI:1295786655
Name:SCHWAB, JOHN KYLE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KYLE
Last Name:SCHWAB
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 1:4660 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9632
Mailing Address - Country:US
Mailing Address - Phone:225-767-8550
Mailing Address - Fax:225-767-8556
Practice Address - Street 1:4660 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9632
Practice Address - Country:US
Practice Address - Phone:225-767-8550
Practice Address - Fax:225-767-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.13571R173F00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1430153Medicaid
LAG79064Medicare UPIN
LA1430153Medicaid