Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 52683 | WI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 52683 | WI |
NPI | 1275798217 |
---|---|
Provider Name | Andrew M Swanson |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53717-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 07/01/2021 |