Healthcare Provider Details

I. General information

NPI: 1831971662
Provider Name (Legal Business Name): MICHAEL SWENGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E PRAIRIE AVE
DECATUR IL
62523-1239
US

IV. Provider business mailing address

173 E PRAIRIE AVE
DECATUR IL
62523-1239
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-2233
  • Fax:
Mailing address:
  • Phone: 217-422-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: