MEDICARE: KATHY D. SWAFFORD 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	208000000X	Pediatrics Physician	036074783	IL
2	2080C0008X	Child Abuse Pediatrics Physician	036074783	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102371	OTHER	IL	HEALTHLINK
2	021175	OTHER	IL	HEALTH ALLIANCE
3	09122971	OTHER	IL	BLUE CROSS/BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871583849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY D. SWAFFORD M.D.

Provider Business Mailing Address
First Line	:	201 E MADISON ST STE 328
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-5131
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W OAK ST
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1400
Country	:	US
Telephone Number	:	618-536-6621
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/13/2024

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