Healthcare Provider Details

I. General information

NPI: 1205191285
Provider Name (Legal Business Name): ANDREW G SWENTIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 190
MARQUETTE MI
49855-5406
US

IV. Provider business mailing address

1414 W FAIR AVE STE 190
MARQUETTE MI
49855-5406
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1321
  • Fax: 906-228-9371
Mailing address:
  • Phone: 906-225-1321
  • Fax: 906-228-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2012020349
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301117513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: