Provider Demographics
NPI: | 1740343151 |
---|---|
Name: | SWIGART, SUSAN E (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | SUSAN |
Middle Name: | E |
Last Name: | SWIGART |
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: | 6525 DREW AVE S |
Mailing Address - Street 2: | |
Mailing Address - City: | EDINA |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55435-2103 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-920-6748 |
Mailing Address - Fax: | 952-920-3863 |
Practice Address - Street 1: | 6525 DREW AVE S |
Practice Address - Street 2: | |
Practice Address - City: | EDINA |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55435-2103 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-920-6748 |
Practice Address - Fax: | 952-920-3863 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-12-18 |
Last Update Date: | 2025-09-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 44404 | 2084P0800X, 2084P0804X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 324G1SW | Other | BCBS MN |
MN | 108323 | Other | UCARE MN |
MN | 324G1SW | Other | BCBS MN |