Provider Demographics
NPI:1356301717
Name:SWANSON, JULIA D (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:D
Last Name:SWANSON
Suffix:
Gender:F
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:765-448-8085
Practice Address - Street 1:1500 SALEM ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2164
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8337
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055782A207Q00000X
IA32798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000636188OtherANTHEM PROVIDER NUMBER
IN200423590Medicaid
IA37298OtherMEDICAL LICENSE
IN815150VMedicare PIN
IN200423590Medicaid
IAI20552Medicare PIN
IAI20838Medicare PIN
IAI20553Medicare PIN
INP00426126Medicare PIN
IN000000636188OtherANTHEM PROVIDER NUMBER
INH82063Medicare UPIN