Provider Demographics
NPI:1811980402
Name:SCHWERDTFEGER, PETIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:PETIE
Middle Name:ANN
Last Name:SCHWERDTFEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PETIE
Other - Middle Name:ANN
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:485 N KS HWY 2
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:KS
Mailing Address - Zip Code:67003-2526
Mailing Address - Country:US
Mailing Address - Phone:620-914-1200
Mailing Address - Fax:620-914-1257
Practice Address - Street 1:485 N KS HWY 2
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2526
Practice Address - Country:US
Practice Address - Phone:620-914-1200
Practice Address - Fax:620-914-1257
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH74969Medicare UPIN