=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164663852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SWATHI R PASHAM M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2009
-----------------------------------------------------
Last Update Date | 04/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22101 MOROSS RD ST JOHN HOSPITAL
-----------------------------------------------------
City | GROSSE POINTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-464-0887
-----------------------------------------------------
Fax | 734-402-0254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4967 CROOKS RD STE 130
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48098-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-952-1601
-----------------------------------------------------
Fax | 248-952-1614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 4301088042
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301088042
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------