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NPI Code Detail

MEDICARE: JAMES SWAN MD

MEDICARE: JAMES SWAN MD
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
1207N00000XDermatology Physician36063593IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316926140
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES SWAN MD
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line : (321 LAGRANGE RD., LAGRANDE PARK, IL.60526)
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-485-1020
Fax Number : 708-485-1173
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line : (321 LAGRANGE RD., LAGRANDE PARK, IL.60526)
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-485-1020
Fax Number : 708-485-1173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 03/05/2010

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