Provider Demographics
NPI:1124073705
Name:MCSWEENEY, AMANDA M (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:MCSWEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N CASEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9704
Mailing Address - Country:US
Mailing Address - Phone:989-453-3798
Mailing Address - Fax:989-453-3819
Practice Address - Street 1:135 N CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-9704
Practice Address - Country:US
Practice Address - Phone:989-453-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28978208600000X
CO50657208600000X
TXK4149208600000X
MI4301060606208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G81015Medicare UPIN