Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-074809 | IL |
NPI | 1033119110 |
---|---|
Provider Name | Rodney O Swan |
First Address | Iron River, MI 49935-9526 |
Second Address | Iron River, MI 49935-9526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 10/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0607120001 | CIGNA GROUP # (01) | IL |
1033119110 | (05) | MI |
1615125 | BLUE SHIELD GROUP # (01) | IL |
C25496 | (02) | IL |
C25496 | (02) | MI |