Provider Demographics
NPI:1629254040
Name:OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-815-2369
Mailing Address - Street 1:1701 E BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8018
Mailing Address - Country:US
Mailing Address - Phone:573-815-2369
Mailing Address - Fax:573-815-2666
Practice Address - Street 1:3165 MCKELVEY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2550
Practice Address - Country:US
Practice Address - Phone:314-996-8105
Practice Address - Fax:314-996-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty