Provider Demographics
NPI:1548217813
Name:SWAMI, SHARAD S (MD)
Entity Type:Individual
Prefix:
First Name:SHARAD
Middle Name:S
Last Name:SWAMI
Suffix:
Gender:M
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:PO BOX 973176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-3176
Mailing Address - Country:US
Mailing Address - Phone:817-466-3408
Mailing Address - Fax:817-466-7285
Practice Address - Street 1:533 S 30TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3656
Practice Address - Country:US
Practice Address - Phone:817-466-3408
Practice Address - Fax:817-466-7285
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18658207R00000X
TXN8580207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100018010AMedicaid
OKF65334Medicare UPIN