Provider Demographics
NPI:1518916337
Name:SWENSON, KERRY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9977 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:847-663-8370
Mailing Address - Fax:847-663-1023
Practice Address - Street 1:9977 WOODS DR
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-663-8370
Practice Address - Fax:847-663-1023
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107460207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH73728Medicare UPIN
IL036-107460Medicare ID - Type Unspecified