MEDICARE: OSWALT GENERAL SURGERY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036.119946	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	217073	OTHER		MEDICARE TTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013171131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSWALT GENERAL SURGERY, P.C.

Provider Business Mailing Address
First Line	:	942 W ROUTE 6
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-8858
Country	:	US
Telephone Number	:	815-513-5650
Fax Number	:	815-513-5652

Provider Business Practice Location Address
First Line	:	942 W ROUTE 6
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-8858
Country	:	US
Telephone Number	:	815-513-5650
Fax Number	:	815-513-5652

Authorized Official
Title or Position	:	M.D.
Name	:	DR. KRISTOPHER MICHAEL OSWALT
Credential	:	M.D
Telephone Number	:	815-513-5650

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/18/2011

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Directions to “OSWALT GENERAL SURGERY, P.C. ” Practice Location

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