Healthcare Provider Details

I. General information

NPI: 1891795241
Provider Name (Legal Business Name): SCOTT A SWENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-3703
US

IV. Provider business mailing address

5775 WAYZATA BLVD SUITE 400
ST LOUIS PARK MN
55416-1222
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-6040
  • Fax: 320-762-6038
Mailing address:
  • Phone: 320-762-6040
  • Fax: 320-762-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25488
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: