Provider Demographics
NPI:1861488777
Name:SWAN, MICHAEL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:SWAN
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 1:329 21ST AVENUE NORTH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1587
Mailing Address - Country:US
Mailing Address - Phone:615-515-9180
Mailing Address - Fax:615-712-7647
Practice Address - Street 1:329 21ST AVE NORTH
Practice Address - Street 2:SUITE 1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1857
Practice Address - Country:US
Practice Address - Phone:615-515-9180
Practice Address - Fax:615-712-7647
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3813224Medicare ID - Type Unspecified
TNG56113Medicare UPIN