Provider Demographics
NPI:1184672727
Name:SWANGIM, JOHN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SWANGIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4119
Mailing Address - Country:US
Mailing Address - Phone:804-273-1717
Mailing Address - Fax:804-368-0242
Practice Address - Street 1:3974 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4119
Practice Address - Country:US
Practice Address - Phone:804-273-1717
Practice Address - Fax:804-368-0242
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000859213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10760823OtherCAQH #
IN000000093446OtherANTHEM
IL91115450OtherBCBS IL PIN #
IN000000248196OtherBCBS PIN #
IN200178550Medicaid
IN000000105251OtherANTHEM BC/BS
INU70769Medicare UPIN
IN000000248196OtherBCBS PIN #
IN10760823OtherCAQH #
IN000000105251OtherANTHEM BC/BS
IN1015030001Medicare NSC
IN480027238Medicare PIN