Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 47286 | MN |
Y | 2080P0208X | Pediatric Infectious Diseases | 47286 | MN |
NPI | 1366479560 |
---|---|
Provider Name | Stephen J Swanson |
First Address | Minneapolis, MN 55415-1623 |
Second Address | Minneapolis, MN 55415-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 11/07/2011 |