Provider Demographics
NPI:1851830343
Name:SZEWS, SAM
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:SZEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4036 BIRNAMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BIRNAMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54414-9609
Mailing Address - Country:US
Mailing Address - Phone:715-581-1582
Mailing Address - Fax:
Practice Address - Street 1:N4036 BIRNAMWOOD RD
Practice Address - Street 2:
Practice Address - City:BIRNAMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54414-9609
Practice Address - Country:US
Practice Address - Phone:715-581-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS2007909537804390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program