Provider Demographics
NPI:1710938592
Name:JOSEPH, SWAPNA (MD)
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:JOSEPH
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 1:855 W. MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-386-1000
Mailing Address - Fax:
Practice Address - Street 1:7836 W. JEFFERSON BLVD. SUITE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-494-3484
Practice Address - Fax:260-969-0173
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052976207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200333510Medicaid
INH32234Medicare UPIN
IN200333510Medicaid
IN925060YYYMedicare ID - Type Unspecified