Basic Information
| Provider Information | |||||||||
| NPI: | 1700117595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM SCHWARTAU LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3868 ERICKSON RD | ||||||||
| Address2: | |||||||||
| City: | BARNUM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557079790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183103124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183123005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2010 | ||||||||
| LastUpdateDate: | 05/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTAU | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2183123005 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25090 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | DQ0613 | 01 | MN | RAILROAD MEDICARE | OTHER | 1602542 | 01 | MEDICA | OTHER | 087K3SC | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 164023 | 01 | MN | UCARE | OTHER | 397277100 | 05 | MN | MEDICAID |