Healthcare Provider Details

I. General information

NPI: 1114914264
Provider Name (Legal Business Name): THOMAS D SCHWIETERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8381 STATE ROUTE 119
MARIA STEIN OH
45860-9701
US

IV. Provider business mailing address

8381 STATE ROUTE 119
MARIA STEIN OH
45860-9701
US

V. Phone/Fax

Practice location:
  • Phone: 419-925-4613
  • Fax: 419-925-4168
Mailing address:
  • Phone: 419-925-4613
  • Fax: 419-925-4168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-8272-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: