Provider Demographics
NPI:1073629697
Name:SWEEN, MICHAEL R (PA)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:R
Last Name:SWEEN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3070 N 51ST ST
Mailing Address - Street 2:#406
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:414-447-5040
Mailing Address - Fax:414-447-5066
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:#406
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-5040
Practice Address - Fax:414-447-5066
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI447363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42984300Medicaid
WI42984300Medicaid