Healthcare Provider Details

I. General information

NPI: 1821053489
Provider Name (Legal Business Name): SWAPNA D DEO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 POPLAR LEVEL RD SUITE 301
LOUISVILLE KY
40217-1395
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-559-3636
  • Fax: 502-636-5137
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01061282A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number39394
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: