Provider Demographics
NPI:1689785305
Name:SWEARINGEN, JEFFREY V (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:V
Last Name:SWEARINGEN
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1818 E WINDSOR RD
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-9566
Practice Address - Country:US
Practice Address - Phone:217-255-9670
Practice Address - Fax:217-255-9724
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080042557OtherRAIL ROAD
ILD88621Medicare UPIN
D88621Medicare UPIN
ILP10143Medicare PIN
IL080042557OtherRAIL ROAD
IL0533210001Medicare NSC
ILIL3270452Medicare PIN