1609845940 NPI number — DR. DENNIS C SZYMANSKI M.D.

Table of content: DR. DENNIS C SZYMANSKI M.D. (NPI 1609845940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609845940 NPI number — DR. DENNIS C SZYMANSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZYMANSKI
Provider First Name:
DENNIS
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609845940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6416 DEANS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERRIEN CENTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49102-9750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-471-7741
Provider Business Mailing Address Fax Number:
269-471-1581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3950 HOLLYWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49085-9159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-556-1990
Provider Business Practice Location Address Fax Number:
269-556-1996
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  4301030282 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2725820 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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