Provider Demographics
NPI:1033119110
Name:SWAN, RODNEY O (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:O
Last Name:SWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W ICE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-9526
Mailing Address - Country:US
Mailing Address - Phone:906-265-6121
Mailing Address - Fax:906-265-4245
Practice Address - Street 1:1400 W ICE LAKE RD
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-9526
Practice Address - Country:US
Practice Address - Phone:906-265-6121
Practice Address - Fax:906-265-4245
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074809207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615125OtherBLUE SHIELD GROUP #
MI1033119110Medicaid
IL0607120001OtherCIGNA GROUP #
ILC25496Medicare UPIN
MIC25496Medicare UPIN
ILCF4186Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
IL200008139Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
ILP11034Medicare PIN
IL1615125OtherBLUE SHIELD GROUP #