Provider Demographics
NPI:1366479560
Name:SWANSON, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:701 PARK AVE # G7
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-2680
Mailing Address - Fax:612-904-4295
Practice Address - Street 1:701 PARK AVE # G7
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2680
Practice Address - Fax:612-904-4295
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN472862080P0208X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist