Healthcare Provider Details

I. General information

NPI: 1295715142
Provider Name (Legal Business Name): MICHAEL I SCHWAB CRNA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S ADAMS ST
CARTHAGE IL
62321-1600
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-3131
  • Fax: 217-357-6564
Mailing address:
  • Phone: 217-357-3131
  • Fax: 217-357-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041344867
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209005494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: