Provider Demographics
NPI:1801080098
Name:HENRY P. SZELAG, D.O., P.C.
Entity type:Organization
Organization Name:HENRY P. SZELAG, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SZELAG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-644-3329
Mailing Address - Street 1:3520 NORTH WOODRUFF ROAD
Mailing Address - Street 2:PO BOX 36
Mailing Address - City:WEIDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48893
Mailing Address - Country:US
Mailing Address - Phone:989-644-3329
Mailing Address - Fax:989-644-3724
Practice Address - Street 1:3520 NORTH WOODRUFF ROAD
Practice Address - Street 2:
Practice Address - City:WEIDMAN
Practice Address - State:MI
Practice Address - Zip Code:48893
Practice Address - Country:US
Practice Address - Phone:989-644-3329
Practice Address - Fax:989-644-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N83080OtherMEDICARE GROUP