Provider Demographics
NPI:1083798276
Name:SWIECA, MITCHELL S (PA)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:SWIECA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 WEST DEYOUNG ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:618-997-9496
Mailing Address - Fax:618-997-8499
Practice Address - Street 1:3331 WEST DEYOUNG ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-997-9496
Practice Address - Fax:618-997-8499
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant