Provider Demographics
NPI:1164527941
Name:SZYMANOWSKI, ROMAULD T (MD)
Entity Type:Individual
Prefix:
First Name:ROMAULD
Middle Name:T
Last Name:SZYMANOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-334-9490
Mailing Address - Fax:248-636-1170
Practice Address - Street 1:7210 N MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1575
Practice Address - Country:US
Practice Address - Phone:248-625-8450
Practice Address - Fax:248-625-4399
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301028561207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM90080Medicare ID - Type UnspecifiedMEDICARE
MAA77137Medicare UPIN