MEDICARE: MITCHELL S SWIECA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1083798276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL S SWIECA PA

Provider Business Mailing Address
First Line	:	3331 WEST DEYOUNG ST
Second Line	:	SUITE 105
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-997-9496
Fax Number	:	618-997-8499

Provider Business Practice Location Address
First Line	:	3331 WEST DEYOUNG ST
Second Line	:	SUITE 105
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-997-9496
Fax Number	:	618-997-8499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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