Provider Demographics
NPI:1053424952
Name:SWANSON, MICHAEL CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLIFFORD
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 BROOK HIGHLAND RDG
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5870
Mailing Address - Country:US
Mailing Address - Phone:205-999-5402
Mailing Address - Fax:205-991-5095
Practice Address - Street 1:201 DOUG BAKER BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2013
Practice Address - Country:US
Practice Address - Phone:205-408-3933
Practice Address - Fax:205-408-3934
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51524038SWAOtherBLUECROSSBLUESHIELD OF AL
AL51524038SWAOtherBLUECROSSBLUESHIELD OF AL
ALP00283239Medicare ID - Type UnspecifiedMEDICARE RAILROAD
AL051524038SWAMedicare ID - Type Unspecified