Provider Demographics
NPI:1962722694
Name:JOHN M SWANGIM DPM PC
Entity type:Organization
Organization Name:JOHN M SWANGIM DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWANGIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-324-8860
Mailing Address - Street 1:1300 STATE ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3185
Mailing Address - Country:US
Mailing Address - Phone:219-324-8860
Mailing Address - Fax:219-324-5671
Practice Address - Street 1:1300 STATE ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3185
Practice Address - Country:US
Practice Address - Phone:219-324-8860
Practice Address - Fax:219-324-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000859A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100019840OtherMEDICARE GROUP/ORGANIZATION PTAN
INM400019841OtherMEDICARE GROUP MEMBER PTAN
IN1184672727OtherGROUP MEMBER NPI
IN200178550Medicaid
IN200992220AOtherGROUP/ORGANIZATION MEDICAID
IN1184672727OtherGROUP MEMBER NPI
IN1962722694Medicare PIN
INU70769Medicare UPIN