Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01056026A | IN |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01056026A | IN |
NPI | 1336197680 |
---|---|
Provider Name | Niles David Schwartz |
First Address | Fort Wayne, IN 46801-2526 |
Second Address | Fort Wayne, IN 46804-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 07/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000476928 | ANTHEM (01) | |
200839910A | (05) | IN |