Individual
BRIAN WILLIS SWANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4294 LAUREL DR, LAKE ODESSA, MI 48849-9423
(616) 374-7660
(616) 374-0270
Mailing address
4294 LAUREL DR, P.O. BOX 578, LAKE ODESSA, MI 48849-9423
(616) 374-7660
(616) 374-0270
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301035130
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0348293
BLUE CROSS BLUE SHIELD MI
MI
05
—
2817978
—
MI
01
—
382376508
TAX IDENTIFICATION
MI
01
—
BS035130
STATE LICENSE MI
MI
Enumeration date
08/29/2006
Last updated
07/08/2007
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