Healthcare Provider Details

I. General information

NPI: 1619016458
Provider Name (Legal Business Name): CASEY SWENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58102-3641
US

IV. Provider business mailing address

200 HAWKINS DR DEPT OF RADIOLOGY
IOWA CITY IA
52242-1007
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2000
  • Fax:
Mailing address:
  • Phone: 319-356-2188
  • Fax: 319-356-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5917
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38534
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: