Healthcare Provider Details

I. General information

NPI: 1437399763
Provider Name (Legal Business Name): THOMAS GERALD SCHWINGHAMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 PASSI RD
ELY MN
55731-8166
US

IV. Provider business mailing address

2232 PASSI ROAD
ELY MN
55731
US

V. Phone/Fax

Practice location:
  • Phone: 530-305-7388
  • Fax: 530-878-7806
Mailing address:
  • Phone: 530-305-7388
  • Fax: 530-878-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number19232
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: