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General NPI Number Information
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NPI Number | 1962722694
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Entity Type | Organization
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Legal Business Name | JOHN M SWANGIM DPM PC
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 1300 STATE ST SUITE 1E
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City | LA PORTE
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State | IN
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Zip | 46350-3185
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Country | US
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Telephone | 219-324-8860
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Fax | 219-324-5671
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Provider Business Mailing Address
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Address Line | 1300 STATE ST SUITE 1E
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City | LA PORTE
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State | IN
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Zip | 46350-3185
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Country | US
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Telephone | 219-324-8860
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Fax | 219-324-5671
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN M SWANGIM
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Credential | DPM
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Telephone | 219-324-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07000859A
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License Number State | IN
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