=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275782377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL G. SWIATEK D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2008
-----------------------------------------------------
Last Update Date | 01/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 PORTLAND WAY S
-----------------------------------------------------
City | GALION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44833-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-462-3465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 N COLUMBUS ST
-----------------------------------------------------
City | CRESTLINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44827-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-462-3465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 36 003565
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------