MEDICARE: SHANNON OPEL SWIFT PA-C

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
2	363A00000X	Physician Assistant	3632	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K400239771	OTHER	WI	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1598146623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON OPEL SWIFT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	800-326-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 S ONEIDA ST
Second Line	:
City	:	ASHWAUBENON
State	:	WI
Zip	:	54304-5230
Country	:	US
Telephone Number	:	920-497-7783
Fax Number	:	920-497-7789

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	08/28/2024

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Directions to “ SHANNON OPEL SWIFT PA-C” Practice Location

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