Basic Information
| Provider Information | |||||||||
| NPI: | 1184672727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANGIM | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N NILES AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466171924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746471700 | ||||||||
| FaxNumber: | 2193245671 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 I ST | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463505533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193241700 | ||||||||
| FaxNumber: | 2193241602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 07000859 | IN | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 000000248196 | 01 | IN | BCBS PIN # | OTHER | 91115450 | 01 | IL | BCBS IL PIN # | OTHER | 000000093446 | 01 | IN | ANTHEM | OTHER | 200178550 | 05 | IN | MEDICAID | 10760823 | 01 | IN | CAQH # | OTHER | 000000105251 | 01 | IN | ANTHEM BC/BS | OTHER |