Provider Demographics
NPI:1215066634
Name:JOHN M SWANGIM DPM
Entity type:Organization
Organization Name:JOHN M SWANGIM DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SWANGIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-395-8752
Mailing Address - Street 1:940 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1047
Mailing Address - Country:US
Mailing Address - Phone:219-395-8752
Mailing Address - Fax:
Practice Address - Street 1:940 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:IN
Practice Address - Zip Code:46304-1047
Practice Address - Country:US
Practice Address - Phone:219-395-8752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000859A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty