Provider Demographics
NPI:1063491207
Name:SWENIE, DENNIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:SWENIE
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 1:200 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1154
Mailing Address - Country:US
Mailing Address - Phone:618-664-2531
Mailing Address - Fax:618-664-2553
Practice Address - Street 1:205 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:IL
Practice Address - Zip Code:62640-1547
Practice Address - Country:US
Practice Address - Phone:217-627-2141
Practice Address - Fax:217-627-3635
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073338Medicaid
BS9653569OtherDEA
BS9653569OtherDEA
D27126Medicare UPIN