Provider Demographics
NPI:1518044601
Name:SWAN, LORI SIEGERT (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SIEGERT
Last Name:SWAN
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 1:2020 UNION ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904
Mailing Address - Country:US
Mailing Address - Phone:765-446-0282
Mailing Address - Fax:765-446-8299
Practice Address - Street 1:2020 UNION ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904
Practice Address - Country:US
Practice Address - Phone:765-446-0282
Practice Address - Fax:765-446-8299
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042461207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN070008454OtherRAILROAD MEDICARE
F79624Medicare UPIN
IN070008454OtherRAILROAD MEDICARE