Provider Demographics
NPI:1245226703
Name:SZEWCZYK, PAUL STANLEY (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:STANLEY
Last Name:SZEWCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4725
Mailing Address - Country:US
Mailing Address - Phone:618-235-2400
Mailing Address - Fax:618-235-0900
Practice Address - Street 1:4900 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4725
Practice Address - Country:US
Practice Address - Phone:618-235-2400
Practice Address - Fax:618-235-0900
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070355207W00000X
MOR1P82207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08215191OtherBCBS
180007717OtherRR MEDICARE
IL08215191OtherBCBS
180007717OtherRR MEDICARE