Provider Demographics
NPI:1912972878
Name:SWANK, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SWANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2315 N LAKE DR
Mailing Address - Street 2:703
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-271-5119
Mailing Address - Fax:414-271-3756
Practice Address - Street 1:2315 N LAKE DR
Practice Address - Street 2:703
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-271-5119
Practice Address - Fax:414-271-3756
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI931519760208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30441600Medicaid
WI000773151Medicare PIN
WI30441600Medicaid
WI000368870Medicare PIN