Provider Demographics
NPI:1174596811
Name:SWIONTONIOWSKI, MARY CONTI (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CONTI
Last Name:SWIONTONIOWSKI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:725 AMERICAN AVENUE
Practice Address - Street 2:ROOM 2036
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-928-5400
Practice Address - Fax:262-928-6140
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-11-08
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Provider Licenses
StateLicense IDTaxonomies
WI46391-020208M00000X
WI46391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34465900Medicaid
D13330Medicare UPIN
WI683750700Medicare PIN