Provider Demographics
NPI:1740273739
Name:SWARTZ, GREGORY L (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 N RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-1138
Practice Address - Country:US
Practice Address - Phone:260-357-6557
Practice Address - Fax:260-357-0373
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2022-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34006589207Q00000X
IN02005119A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4796106Medicaid
OH2317415Medicaid
MI4796090Medicaid
MI4796106Medicaid
MI4796090Medicaid