Provider Demographics
NPI:1790703692
Name:SWICK, SHAWN M (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:SWICK
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 1:222 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2241
Mailing Address - Country:US
Mailing Address - Phone:937-382-0918
Mailing Address - Fax:937-383-1123
Practice Address - Street 1:222 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2241
Practice Address - Country:US
Practice Address - Phone:937-382-0918
Practice Address - Fax:937-383-1123
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2549577Medicaid
OHI26802Medicare UPIN
OH2549577Medicaid
OHP00407071Medicare PIN
OH9915141Medicare PIN