Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 01052492 | IN |
NPI | 1720073356 |
---|---|
Provider Name | Andrew Lawrence Schwaderer |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2558950 | (05) | OH |
J32646 | (02) |