MEDICARE: BRUCE SWAIN

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1255881181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE SWAIN

Provider Business Mailing Address
First Line	:	2800 FREEWAY BLVD
Second Line	:	SUITE 203
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	763-441-8998
Fax Number	:	763-441-7291

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD
Second Line	:	SUITE 203
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	763-441-8998
Fax Number	:	763-441-7291

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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Directions to “ BRUCE SWAIN ” Practice Location

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