Healthcare Provider Details

I. General information

NPI: 1164742227
Provider Name (Legal Business Name): CHRISTOPHER NEIL SWEIGART D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S 3RD ST
BELLEVILLE IL
62220-1952
US

IV. Provider business mailing address

1531 S 8TH ST UNIT 326
SAINT LOUIS MO
63104-3855
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7880
  • Fax:
Mailing address:
  • Phone: 812-887-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125057526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: