Provider Demographics
NPI:1376137083
Name:SWAN PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:SWAN PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOINUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-456-0307
Mailing Address - Street 1:303 E ARMY TRAIL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2140
Mailing Address - Country:US
Mailing Address - Phone:630-931-2929
Mailing Address - Fax:833-731-0578
Practice Address - Street 1:303 E ARMY TRAIL RD STE 111
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2140
Practice Address - Country:US
Practice Address - Phone:630-931-2929
Practice Address - Fax:833-731-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty