Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP999 | MI |
NPI | 1255380952 |
---|---|
Provider Name | Mr. Thomas Szczytko |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49503-2550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 04/03/2008 |