Healthcare Provider Details

I. General information

NPI: 1780028332
Provider Name (Legal Business Name): MICHAEL KENNETH SCHOWALTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SPRINGER DR
LOMBARD IL
60148-6413
US

IV. Provider business mailing address

820 SPRINGER DR
LOMBARD IL
60148-6413
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-8554
  • Fax: 630-495-1770
Mailing address:
  • Phone: 724-493-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036146297
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number036146297
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: