Provider Demographics
NPI:1457639601
Name:SWARTZ, TRAVIS DAVID (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:DAVID
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 WASHINGTON AVENUE
Mailing Address - Street 2:EH ST MARY'S-DETROIT LAKES CLINIC
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3904
Mailing Address - Country:US
Mailing Address - Phone:218-847-5611
Mailing Address - Fax:
Practice Address - Street 1:1027 WASHINGTON AVENUE
Practice Address - Street 2:EH ST MARY'S DETROIT LAKES CLINIC
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3904
Practice Address - Country:US
Practice Address - Phone:218-847-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL 11982208600000X
MN62268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery