Provider Demographics
NPI:1760956734
Name:SWEATLAND, CODY ALLEN
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ALLEN
Last Name:SWEATLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2578
Mailing Address - Country:US
Mailing Address - Phone:989-751-1624
Mailing Address - Fax:
Practice Address - Street 1:3504 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2143
Practice Address - Country:US
Practice Address - Phone:989-751-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7118004171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor