Provider Demographics
NPI:1922157239
Name:SWENSON, ERIK A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:A
Last Name:SWENSON
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 1:9550 W 167TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5561
Mailing Address - Country:US
Mailing Address - Phone:708-873-4500
Mailing Address - Fax:708-873-4505
Practice Address - Street 1:9550 W 167TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5561
Practice Address - Country:US
Practice Address - Phone:708-873-4500
Practice Address - Fax:708-873-4505
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.097502208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615715OtherBLUE CROSS BLUE SHIELD
IL036097502Medicaid
672910Medicare PIN
IL036097502Medicaid