Basic Information
| Provider Information | |||||||||
| NPI: | 1801080098 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENRY P. SZELAG, D.O., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 NORTH WOODRUFF ROAD | ||||||||
| Address2: | PO BOX 36 | ||||||||
| City: | WEIDMAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896443329 | ||||||||
| FaxNumber: | 9896443724 | ||||||||
| Practice Location | |||||||||
| Address1: | 3520 NORTH WOODRUFF ROAD | ||||||||
| Address2: | |||||||||
| City: | WEIDMAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896443329 | ||||||||
| FaxNumber: | 9896443724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2007 | ||||||||
| LastUpdateDate: | 08/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | SZELAG | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9896443329 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101009907 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0N83080 | 01 | MI | MEDICARE GROUP | OTHER |