Provider Demographics
NPI:1316044613
Name:SZELAG, HENRY PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:PAUL
Last Name:SZELAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 NORTH WOODRUFF ROAD
Mailing Address - Street 2:PO BOX 36
Mailing Address - City:WEIDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48893
Mailing Address - Country:US
Mailing Address - Phone:989-644-3329
Mailing Address - Fax:989-644-3724
Practice Address - Street 1:3520 NORTH WOODRUFF ROAD
Practice Address - Street 2:
Practice Address - City:WEIDMAN
Practice Address - State:MI
Practice Address - Zip Code:48893
Practice Address - Country:US
Practice Address - Phone:989-644-3329
Practice Address - Fax:989-644-3724
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853700035OtherBCBS
MI0853701254OtherBCBS
MI2580358Medicaid
MIN83080001Medicare ID - Type Unspecified
MI0853700035OtherBCBS