Provider Demographics
NPI:1124078977
Name:SWABASH, KIRK PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:PAUL
Last Name:SWABASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KIRK
Other - Middle Name:PAUL
Other - Last Name:SWABASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1500 WEISS ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5251
Mailing Address - Country:US
Mailing Address - Phone:989-497-2500
Mailing Address - Fax:
Practice Address - Street 1:5739 HIGHWAY M-68
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9998
Practice Address - Country:US
Practice Address - Phone:608-821-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010086852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260B410160OtherBCBS
MI4088017Medicaid
MIOM76260Medicare ID - Type Unspecified