MEDICARE: DR. DONALD M SCHWARTZ

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	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1629195565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD M SCHWARTZ

Provider Business Mailing Address
First Line	:	1710 MAPLE AVE
Second Line	:	#1530
City	:	EVANSTON
State	:	IL
Zip	:	60201-3134
Country	:	US
Telephone Number	:	847-332-2524
Fax Number	:	847-332-2534

Provider Business Practice Location Address
First Line	:	1710 MAPLE AVE
Second Line	:	#1530
City	:	EVANSTON
State	:	IL
Zip	:	60201-3134
Country	:	US
Telephone Number	:	847-332-2524
Fax Number	:	847-332-2534

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

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	07/08/2007

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