Healthcare Provider Details

I. General information

NPI: 1063501922
Provider Name (Legal Business Name): THOMAS L. SCHWENK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 17TH STREET, MAIL STOP 316 BRIGHAM BUILDING
RENO NV
89557
US

IV. Provider business mailing address

401 WEST 2ND STREET NELSON/227/MAIL STOP 353
RENO NV
89503
US

V. Phone/Fax

Practice location:
  • Phone: 775-784-1533
  • Fax: 775-784-8075
Mailing address:
  • Phone: 775-784-1223
  • Fax: 775-327-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301047795
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301047795
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14002
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: