Provider Demographics
NPI:1972607158
Name:SWANN, MICHAEL H (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:H
Last Name:SWANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3850 S NATIONAL AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5287
Mailing Address - Country:US
Mailing Address - Phone:417-888-0858
Mailing Address - Fax:417-889-0476
Practice Address - Street 1:3850 S NATIONAL AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5287
Practice Address - Country:US
Practice Address - Phone:417-888-0858
Practice Address - Fax:417-889-0476
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2007005538207ND0101X, 207NS0135X
MO2003014484207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology