MEDICARE: MR. ILYA SCHWARTZMAN MD

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	207Q00000X	Family Medicine Physician	01037683A	IN
2	207Q00000X	Family Medicine Physician	01037683	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003944	OTHER		SIHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000089434	OTHER	IN	ANTHEM
4	000000990927	OTHER	IN	ANTHEM PIN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	351896225100	OTHER	IN	CARESOURCE
7	351896225	OTHER		COMMERCIAL

General Provider Information

NPI Number	:	1144252552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ILYA SCHWARTZMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5383
Country	:	US
Telephone Number	:	812-376-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	3581 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2036
Country	:	US
Telephone Number	:	812-376-9601
Fax Number	:	812-378-8518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/06/2024

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Directions to “ MR. ILYA SCHWARTZMAN MD” Practice Location

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