Healthcare Provider Details

I. General information

NPI: 1649614793
Provider Name (Legal Business Name): AMANDA ELAINE SCHWARTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 REGENT ST
MADISON WI
53705-4901
US

IV. Provider business mailing address

4410 REGENT ST
MADISON WI
53705-4901
US

V. Phone/Fax

Practice location:
  • Phone: 608-233-9746
  • Fax: 608-236-1981
Mailing address:
  • Phone: 608-233-9746
  • Fax: 608-236-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number62694
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: