Provider Demographics
NPI:1295811016
Name:SWAIN, SANDRA FAITH (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:FAITH
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:FAITH
Other - Last Name:SWAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2802 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-8428
Mailing Address - Country:US
Mailing Address - Phone:708-532-0330
Mailing Address - Fax:847-680-3844
Practice Address - Street 1:501 PETERSON RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1082
Practice Address - Country:US
Practice Address - Phone:708-532-0330
Practice Address - Fax:847-680-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3360795752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079575Medicaid
ILE74862Medicare UPIN
IL972840Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO.