Provider Demographics
NPI:1760415830
Name:SZLOBODA, KATALIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KATALIN
Middle Name:B
Last Name:SZLOBODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W ICE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-9526
Mailing Address - Country:US
Mailing Address - Phone:906-265-6121
Mailing Address - Fax:906-265-4245
Practice Address - Street 1:1328 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-1045
Practice Address - Country:US
Practice Address - Phone:906-875-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1101600251OtherINDIVIDUAL BLUE CROSS
MI4745626Medicaid
MI110A610070OtherGROUP BLUE CROSS
MI4745626Medicaid
MI110A610070OtherGROUP BLUE CROSS