Healthcare Provider Details

I. General information

NPI: 1063587764
Provider Name (Legal Business Name): WILLIAM JAMES SWIFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N BLACKHAWK AVE SUITE 100
MADISON WI
53705-3357
US

IV. Provider business mailing address

702 N BLACKHAWK AVE SUITE 100
MADISON WI
53705-3357
US

V. Phone/Fax

Practice location:
  • Phone: 608-663-5926
  • Fax: 608-663-5928
Mailing address:
  • Phone: 608-663-5926
  • Fax: 608-663-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17718-020
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1063587764
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: