Provider Demographics
NPI:1750321261
Name:SWIACKI, GERALD R (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:R
Last Name:SWIACKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 THRUSH CT
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-1931
Mailing Address - Country:US
Mailing Address - Phone:239-394-9285
Mailing Address - Fax:
Practice Address - Street 1:667 THRUSH CT
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-1931
Practice Address - Country:US
Practice Address - Phone:239-394-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS2716208600000X
MI006092208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1351987Medicaid
MI5633295Medicare ID - Type Unspecified
E25941Medicare UPIN