Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25911 | MN |
NPI | 1851518674 |
---|---|
Provider Name | Dr. Edward Henry Szachowicz |
First Address | Edina, MN 55435-4549 |
Second Address | Edina, MN 55435-4549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D81101 | (02) | MN |