MEDICARE: JESSICA L SWENBERG 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	01052923A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00116645	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000313041	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295755684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA L SWENBERG MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	STE 130 PROVIDER ENROLLMENT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 BRENDON WAY
Second Line	:	SUITE 800
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1955
Country	:	US
Telephone Number	:	317-777-6400
Fax Number	:	317-777-6410

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/27/2014

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