Provider Demographics
NPI:1457103269
Name:SWIDER-EBELS, ALLISON RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:RENEE
Last Name:SWIDER-EBELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALLISON
Other - Middle Name:RENEE
Other - Last Name:SWIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGN ST NE STE A601
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-6243
Mailing Address - Fax:616-391-8611
Practice Address - Street 1:100 MICHIGN ST NE STE A601
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-6243
Practice Address - Fax:616-391-8611
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052869208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery