Provider Demographics
NPI:1548350341
Name:TOMASZCZYK, MICHAEL C (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:TOMASZCZYK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST
Mailing Address - Street 2:STE 207
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-722-2260
Mailing Address - Fax:231-722-3084
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:STE 207
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-722-2260
Practice Address - Fax:231-722-3084
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMT009748208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3242050Medicaid
MI3242050Medicaid
MI0M21910Medicare ID - Type Unspecified