Provider Demographics
NPI:1649938390
Name:SZELWACH, MICHAL KRZYSZLOF (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAL
Middle Name:KRZYSZLOF
Last Name:SZELWACH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 OCEAN HWY W
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4012
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:910-251-0421
Practice Address - Street 1:5160 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4012
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:910-251-0421
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC397730042OtherNSC #