Basic Information
| Provider Information | |||||||||
| NPI: | 1629050372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWABER | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD | ||||||||
| Address2: | SUITE LL-50 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862300 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152972700 | ||||||||
| FaxNumber: | 6153862197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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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 | 207YX0901X | MD13485 | TN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology |
ID Information
| ID | Type | State | Issuer | Description | 30228621 | 05 | TN | MEDICAID | 4067886 | 01 | TN | AETNA | OTHER | 10604176 | 01 | CIGNA | OTHER | 4166594 | 01 | TN | BCBS OF TN | OTHER | TN0138 | 01 | TN | AMERICHOICE | OTHER | 01159184 | 01 | TN | AMERIGROUP | OTHER | 6479027200 | 05 | KY | MEDICAID | 259244 | 01 | USA MANAGED CARE | OTHER | 1506114 | 05 | TN | MEDICAID |