Provider Demographics
NPI:1588051833
Name:TODD SWENNING MD PC
Entity type:Organization
Organization Name:TODD SWENNING MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-416-4511
Mailing Address - Street 1:PO BOX 1623
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1057
Mailing Address - Country:US
Mailing Address - Phone:760-416-4511
Mailing Address - Fax:909-533-2225
Practice Address - Street 1:1180 N INDIAN CANYON DR STE 201
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4857
Practice Address - Country:US
Practice Address - Phone:760-416-4511
Practice Address - Fax:909-533-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1348662086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH75201Medicare UPIN