Basic Information
| Provider Information | |||||||||
| NPI: | 1467488932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINSLOW | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491202281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696871136 | ||||||||
| FaxNumber: | 2694080996 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 HOLLYWOOD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490859151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694290900 | ||||||||
| FaxNumber: | 2694080996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 04/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301043373 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4661992 | 05 | MI | MEDICAID | 27-0381199 | 01 | MI | GROUP TAX ID | OTHER | 0201102022 | 01 | MI | BLUE CROSS | OTHER | AW2604139 | 01 | MI | DEA | OTHER | 1538397120 | 01 | MI | GROUP NPI | OTHER |