Healthcare Provider Details

I. General information

NPI: 1285724310
Provider Name (Legal Business Name): LEO A SCHWENDAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BLANKENBAKER PKWY STE 200
LOUISVILLE KY
40243-1850
US

IV. Provider business mailing address

PO BOX 950187
LOUISVILLE KY
40295-0187
US

V. Phone/Fax

Practice location:
  • Phone: 502-554-4925
  • Fax: 502-244-9860
Mailing address:
  • Phone: 502-238-2801
  • Fax: 502-238-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27341
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: