Provider Demographics
NPI:1790750701
Name:SWANSON, KYLE CHRISTOPHER (MD)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:SWANSON
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 1:1431 PREMIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DRIVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:507-625-5971
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40171207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0900826OtherMEDICA, HUTCH OFFICE
MN155T0SWOtherBCBS OF MN
MN518024400Medicaid
MN410940705H027OtherTRICARE/WPS
MN0900786OtherMEDICA, HUTCH HOSP
MN0900709OtherMEDICA, MANKATO
MNHP35439OtherHEALTH PARTNERS
MN983181031031OtherPREFERRED ONE
MN124087C572OtherUCARE MN
MNHP35439OtherHEALTH PARTNERS
MN0900709OtherMEDICA, MANKATO
MN124087C572OtherUCARE MN