Basic Information
| Provider Information | |||||||||
| NPI: | 1104937044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423130 | ||||||||
| FaxNumber: | 8122423596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1429 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423130 | ||||||||
| FaxNumber: | 8122423596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 01045244A | IN | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 36094330 | IL | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 200106500P | 05 | IN | MEDICAID | 200106500Z | 05 | IN | MEDICAID | P00866712 | 01 | IL | RAILROAD MEDICARE | OTHER | 200106500 | 05 | IN | MEDICAID | 000000089637 | 01 | ANTHEM | OTHER | 340016673 | 01 | RAILROAD MCARE PALAMETTO | OTHER | 340011973 | 01 | RAILROAD MCARE PALAMETTO | OTHER | P00818724 | 01 | IN | RAILROAD MEDICARE | OTHER |