Provider Demographics
NPI:1457856510
Name:SWDC MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SWDC MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-622-8161
Mailing Address - Street 1:2301 COUNTRYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4519
Mailing Address - Country:US
Mailing Address - Phone:812-698-9323
Mailing Address - Fax:
Practice Address - Street 1:2301 COUNTRYVIEW DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4519
Practice Address - Country:US
Practice Address - Phone:812-698-9323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300061277Medicaid