Basic Information
| Provider Information | |||||||||
| NPI: | 1780023135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWAIN | ||||||||
| FirstName: | SANJAYA | ||||||||
| MiddleName: | KUMAR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 NW 14TH STREET SUITE 1560 | ||||||||
| Address2: | CLINICAL RESEARCH BUILDING, DEPARTMENT OF UROLOGY | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052433670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1150 PAC CLINIC UNIVERSITY OF MIAMI HOSPITAL | ||||||||
| Address2: | ROOM NO 309 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052437217 | ||||||||
| FaxNumber: | 3052432919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2013 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 04/03/2014 | ||||||||
| NPIReactivationDate: | 06/04/2015 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TRN18548 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | MFC1746 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.