Healthcare Provider Details

I. General information

NPI: 1023274479
Provider Name (Legal Business Name): LYLE J. SWENSON, M.D, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 HIGHWAY 55 SUITE #130
EAGAN MN
55121-2156
US

IV. Provider business mailing address

2854 HIGHWAY 55 SUITE #130
EAGAN MN
55121-2156
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-4930
  • Fax:
Mailing address:
  • Phone: 651-224-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LYLE J SWENSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 612-747-9569