Provider Demographics
NPI:1780028332
Name:SCHOWALTER, MICHAEL KENNETH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNETH
Last Name:SCHOWALTER
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 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:724-493-2876
Mailing Address - Fax:
Practice Address - Street 1:820 SPRINGER DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6413
Practice Address - Country:US
Practice Address - Phone:815-744-8554
Practice Address - Fax:630-495-1770
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146297207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology