| Doctor Name: | KEVIN DALE SWENSON |
| NPI Number: | 1821403635 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2102 |
| Business Practice Address: | 1000 Coney St W Perham, MN - 565732102 |
| Business Phone Number: | 2183474500 |
| Business Fax Number: | |
| Mailing Address: | 201 Fox Run, PERHAM |
| State: | MN |
| Postal Code: | 565732403 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2014 |
| NPI Last Update Date: | 07/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |