Provider Demographics
NPI:1750512778
Name:SCHWADERER, RENEE M (DO)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:SCHWADERER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:MISTOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3912
Mailing Address - Country:US
Mailing Address - Phone:614-268-8164
Mailing Address - Fax:614-268-8406
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 1080
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-268-8164
Practice Address - Fax:614-268-8406
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010434208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070327Medicaid
OH0070327Medicaid