Healthcare Provider Details

I. General information

NPI: 1124100862
Provider Name (Legal Business Name): RONALD PAUL SWENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W SAGINAW ST 5TH FLOOR - I.S.
LANSING MI
48915-1927
US

IV. Provider business mailing address

4450 RODEO TRL
WILLIAMSTON MI
48895-9439
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-6400
  • Fax: 517-364-6402
Mailing address:
  • Phone: 517-364-6400
  • Fax: 517-364-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301035300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: