Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301089412 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 38863 | IA |
NPI | 1174722912 |
---|---|
Provider Name | Dr. Carla Mavourneen Schwalm |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174722912 | (05) | IA |
175150040 | MEDICARE (01) | IA |