Provider Demographics
NPI:1972562031
Name:SWANSON, KAREN MARIE (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:SWANSON
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 1:26711 WOODWARD AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-543-6000
Mailing Address - Fax:248-543-3770
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:STE 103
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-543-6000
Practice Address - Fax:248-543-3770
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS045311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B49245Medicare UPIN
N56290002Medicare ID - Type Unspecified