Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036091548 | IL |
N | 207RG0100X | Gastroenterologist | 118062 | MO |
NPI | 1033642509 |
---|---|
Provider Name | Abdul Monem Swied |
First Address | Springfield, IL 62794-9636 |
Second Address | Springfield, IL 62702-4968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-091548 | STATE LICENSE (01) | IL |