Provider Demographics
NPI:1740367168
Name:SCHWARTZ, ALLAN (DO)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21310 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5545
Mailing Address - Country:US
Mailing Address - Phone:248-357-2912
Mailing Address - Fax:510-743-4249
Practice Address - Street 1:21310 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5545
Practice Address - Country:US
Practice Address - Phone:248-357-2912
Practice Address - Fax:510-743-4249
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0156303015OtherBLUE CROSS
MI1655392 11Medicaid
MIMI3879001Medicare PIN
MIE25528Medicare UPIN