Individual
DR. CHARLES EDWARD SWALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
260525-1205
UT
2085R0202X
Diagnostic Radiology Physician
260525-1205
UT
2085R0202X
Diagnostic Radiology Physician
Primary
4301501168
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003921900
—
ID
05
—
100505539
—
NV
05
—
120391600
—
WY
05
—
8127936
—
CA
05
—
924458
—
AZ
05
—
D1508
—
UT
01
—
P00199656
RR MEDICARE
UT
01
—
P00651563
RR MEDICARE
UT
Enumeration date
07/06/2005
Last updated
05/04/2020
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