person
Brian Willis Swanton, MD
General Practice Physician in Lake Odessa, Michigan
NPI 1972612547

Brian Willis Swanton is a General Practice Physician based in Lake Odessa, MI. Brian Willis Swanton practices in Lake Odessa, MI and has the professional credentials of MD. The NPI Number for Brian Willis Swanton is 1972612547 and holds a License No. 4301035130 (Michigan).

The current practice location address for Brian Willis Swanton is 4294 Laurel Dr, Lake Odessa, MI and can be reached out via phone at 616-374-7660 and via fax at 616-374-0270.

Location: 4294 Laurel Dr, Lake Odessa, MI, 48849-9423
person
Provider Profile Details
NPI Number
1972612547
Provider Name
Brian Willis Swanton
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
4294 Laurel Dr, Lake Odessa, MI, 48849-9423
Phone Number
616-374-7660
Fax Number
616-374-0270
Provider Enumeration Date
08/29/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2817978 05 MI
382376508 01 MI TAX IDENTIFICATION
0348293 01 MI BLUE CROSS BLUE SHIELD MI
BS035130 01 MI STATE LICENSE MI
institution
Provider Business Practice Location Address Details
Address
4294 Laurel Dr
City
State
Zip
48849-9423
Phone Number
616-374-7660
Fax Number
616-374-0270
person
Provider Business Mailing Address Details
Address
4294 Laurel Dr
City
State
Zip
48849-9423
Phone Number
616-374-7660
Fax Number
616-374-0270
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
License No.
4301035130 (Michigan)
Definition
Definition to come...
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