Provider Demographics
NPI:1659437267
Name:SWANN, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SWANN
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 1:1400 CORPORATE CENTER CURV STE 200
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1372
Mailing Address - Country:US
Mailing Address - Phone:651-968-5300
Mailing Address - Fax:
Practice Address - Street 1:1400 CORPORATE CENTER CURV STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1372
Practice Address - Country:US
Practice Address - Phone:651-968-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN649262083X0100X
CAG 69836207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE787FMedicare PIN
CACK436YMedicare UPIN
CACK436VMedicare UPIN
CACK436UMedicare UPIN
CACE787CMedicare PIN
CAZZZ07334ZMedicare PIN
CACE787EMedicare PIN
CACE787BMedicare PIN
CACK436XMedicare UPIN
CACK436WMedicare UPIN
CACE787DMedicare PIN
CACK436TMedicare UPIN
CACK436ZMedicare UPIN
CACE787AMedicare PIN