Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
Neurosurgery/Headache Medicine a Department of SwedishAmerican Hospita
Organization subpart
No
Provider details
NPI number
Authorized official
DON DANIELS (VP)
(815) 966-2084
Entity
Organization
Contact information
Practice address
1340 CHARLES ST, SUITE 400, ROCKFORD, IL 61104
(779) 696-9512
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
062
TRICARE
IL
Enumeration date
07/17/2009
Last updated
07/12/2018
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