MEDICARE: DR. GERALD ERNEST SWANSON M.D.

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	207R00000X	Internal Medicine Physician	17405	MN

General Provider Information

NPI Number	:	1609850510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD ERNEST SWANSON M.D.

Provider Business Mailing Address
First Line	:	7514 LANDAU DR
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55438-2312
Country	:	US
Telephone Number	:	952-303-6726
Fax Number	:	952-303-6727

Provider Business Practice Location Address
First Line	:	7514 LANDAU DR
Second Line	:	SUITE 315
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55438-2312
Country	:	US
Telephone Number	:	952-303-6726
Fax Number	:	952-303-6727

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	08/11/2009

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