Healthcare Provider Details

I. General information

NPI: 1285977348
Provider Name (Legal Business Name): MACKENZIE MARIE SWARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S FIRST AVE LOYOLA UNIVERSITY MEDICAL CENTER DEPT OF OPHTHALMOLOGY
MAYWOOD IL
60153-6809
US

IV. Provider business mailing address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 320-219-0531
  • Fax:
Mailing address:
  • Phone: 320-219-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.064337
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: