Individual
CHARLES SWANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(866) 600-2273
Mailing address
13328 GORGET DR, SOUTH LYON, MI 48178-9524
(248) 303-2587
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301506310
MI
208000000X
Pediatrics Physician
4301506310
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2018
Last updated
05/09/2023
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