Healthcare Provider Details

I. General information

NPI: 1962486266
Provider Name (Legal Business Name): ROBERT MUROL SWEENEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE. 4440
SOUTH BEND IN
46601-1156
US

IV. Provider business mailing address

328 N MICHIGAN ST STE. 200
SOUTH BEND IN
46601-1244
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-4540
  • Fax:
Mailing address:
  • Phone: 574-647-1845
  • Fax: 574-647-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01019126A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: