Provider Demographics
NPI:1174518393
Name:SCHWARTZ, MARY ELLEN (DPM)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1744
Mailing Address - Country:US
Mailing Address - Phone:574-316-0306
Mailing Address - Fax:574-239-0478
Practice Address - Street 1:116 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1744
Practice Address - Country:US
Practice Address - Phone:574-935-4068
Practice Address - Fax:574-935-4058
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000938A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200353690Medicaid
INP00403293OtherMEDICARE RAILROAD
IN000000521416OtherANTHEM
INP00403293OtherMEDICARE RAILROAD
U88456Medicare UPIN