Provider Demographics
NPI:1902999550
Name:M. ELIZABETH SWENOR, DO, PC
Entity Type:Organization
Organization Name:M. ELIZABETH SWENOR, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SWENOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-487-2340
Mailing Address - Street 1:2390 MITCHELL PARK DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-487-9355
Mailing Address - Fax:231-487-1737
Practice Address - Street 1:2390 MITCHELL PARK DR
Practice Address - Street 2:UNIT D
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-487-9355
Practice Address - Fax:231-487-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315016050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4954920Medicaid
MIH98275Medicare UPIN
MI0P35710Medicare ID - Type Unspecified