Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
Rockford Vascular Surgery A Department of SwedishAmerican Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
DON DANIELS (VP)
(815) 966-2084
Entity
Organization
Contact information
Practice address
1340 CHARLES ST STE 200, ROCKFORD, IL 61104
(779) 696-8799
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043
TRICARE SUFFIX #
IL
Enumeration date
07/21/2014
Last updated
07/12/2018
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