Provider Demographics
NPI:1669416814
Name:SWANSON, MICHAEL J (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Mailing Address - Street 2:SUITE 425
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2366
Mailing Address - Country:US
Mailing Address - Phone:216-643-2780
Mailing Address - Fax:216-524-0111
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:SUITE 425
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2366
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:216-524-0111
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-8468208G00000X
OH34008468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001674Medicaid
OH2547435Medicaid
OHHO9339741Medicare ID - Type UnspecifiedOH GROUP PROVIDER #
OHSW4156551Medicare ID - Type UnspecifiedOH INDIVIDUAL PROVIDER #
OH9339741Medicare ID - Type UnspecifiedELECTRONIC ANSI GROUP #
WV3810001674Medicaid
OH2547435Medicaid
OHH033001Medicare PIN