Provider Demographics
NPI:1306838404
Name:SZYMANSKI, SALLY ROSE (DO)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ROSE
Last Name:SZYMANSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1226
Mailing Address - Country:US
Mailing Address - Phone:734-649-4124
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-649-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010087412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4394324Medicaid
MION44690Medicare ID - Type Unspecified
MI4394324Medicaid