Provider Demographics
NPI:1457517740
Name:SCHWACK, BRADLEY FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:FRANKLIN
Last Name:SCHWACK
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 1:4121 DUTCHMANS LN
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4707
Mailing Address - Country:US
Mailing Address - Phone:502-899-6405
Mailing Address - Fax:
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:SUITE 503
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-899-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248356208600000X
KY42655208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3730433000OtherNHWM
1105796OtherNHWM/SIHO
KY7100071890Medicaid
000026447ZOtherNHWM/HUMANA
50025056OtherNHWM/PHP
KY7100071890Medicaid