Healthcare Provider Details

I. General information

NPI: 1518044601
Provider Name (Legal Business Name): LORI SIEGERT SWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 UNION ST SUITE 300
LAFAYETTE IN
47904
US

IV. Provider business mailing address

2020 UNION ST SUITE 300
LAFAYETTE IN
47904
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-0282
  • Fax: 765-446-8299
Mailing address:
  • Phone: 765-446-0282
  • Fax: 765-446-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01042461
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: