Healthcare Provider Details

I. General information

NPI: 1629456546
Provider Name (Legal Business Name): CHAD MITCHELL SCHWALB D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21647 RYAN RD
WARREN MI
48091
US

IV. Provider business mailing address

3095 SHADYDALE LN
WEST BLOOMFIELD MI
48323-1853
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-7777
  • Fax: 586-754-7781
Mailing address:
  • Phone: 248-408-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: