Provider Demographics
NPI:1821053489
Name:DEO, SWAPNA D (MD)
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:D
Last Name:DEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-559-3636
Practice Address - Fax:502-636-5137
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061282A207R00000X
KY39394207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2743954000OtherPASSPORT ADVANTAGE / NCMA
INP00331955OtherRAILROAD MEDICARE
KY065493OtherSIHO / NCMA
KY1224862OtherCHA / NCMA
KY000000376589OtherANTHEM / NCMA
KY0000230250OtherHUMANA / NCMA
MA50011284OtherPASSPORT / NCMA
KYP00288688OtherRAILROAD MEDICARE
IN200538850Medicaid
KY64114689Medicaid
KY9716743OtherCIGNA / NCMA
KY065493OtherSIHO / NCMA
KYP00288688OtherRAILROAD MEDICARE
KY64114689Medicaid