Basic Information
| Provider Information | |||||||||
| NPI: | 1386649093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWERTFEGER | ||||||||
| FirstName: | TY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2135 N COLLECTIVE LN | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162613220 | ||||||||
| FaxNumber: | 3162613298 | ||||||||
| Practice Location | |||||||||
| Address1: | 2135 N COLLECTIVE LN | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162613220 | ||||||||
| FaxNumber: | 3162613298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204R00000X | 04-23810 | KS | N | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine | 2084N0400X | 04-23810 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.