Provider Demographics
NPI:1861663007
Name:SWAIN, GEOFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:R
Last Name:SWAIN
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 1:841 N BROADWAY FL 3
Mailing Address - Street 2:CITY OF MILWAUKEE HEALTH DEPARTMENT
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3639
Mailing Address - Country:US
Mailing Address - Phone:414-286-3521
Mailing Address - Fax:414-286-5990
Practice Address - Street 1:841 N BROADWAY FL 3
Practice Address - Street 2:CITY OF MILWAUKEE HEALTH DEPARTMENT
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3639
Practice Address - Country:US
Practice Address - Phone:414-286-3521
Practice Address - Fax:414-286-5990
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31547400Medicaid
WI73601Medicare PIN
WI31547400Medicaid