| Organization Name: | GRANITE CITY CLINIC CORP |
| NPI Number: | 1255387957 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL SWAW (DIRECTOR) |
| Mailing Address: | 2044 Madison Ave Suite 27 Granite City |
| State: | IL US |
| Postal Code: | 620404641 |
| Phone Number: | 6184517600 |
| Fax Number: | 6184517685 |
| NPI Enumeration Date: | 05/25/2006 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |