Healthcare Provider Details

I. General information

NPI: 1770763773
Provider Name (Legal Business Name): BRIAN W SWANTON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4294 LAUREL DR
LAKE ODESSA MI
48849-9423
US

IV. Provider business mailing address

4294 LAUREL DR PO BOX 578
LAKE ODESSA MI
48849-9423
US

V. Phone/Fax

Practice location:
  • Phone: 616-374-7660
  • Fax: 616-374-0270
Mailing address:
  • Phone: 616-374-7660
  • Fax: 616-374-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN W SWANTON
Title or Position: OFFICER
Credential: MD
Phone: 616-374-7660