Healthcare Provider Details

I. General information

NPI: 1700117595
Provider Name (Legal Business Name): WILLIAM SCHWARTAU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E 25TH ST
HIBBING MN
55746-3897
US

IV. Provider business mailing address

3868 ERICKSON RD
BARNUM MN
55707-9790
US

V. Phone/Fax

Practice location:
  • Phone: 218-312-3005
  • Fax:
Mailing address:
  • Phone: 218-310-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25090
License Number StateMN

VIII. Authorized Official

Name: WILLIAM SCHWARTAU
Title or Position: OWNER
Credential: M.D.
Phone: 218-312-3005