Provider Demographics
NPI:1649261348
Name:SZCZEPANSKI, JEFFREY A (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:SZCZEPANSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 E PICKWICK CT STE E
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5239
Mailing Address - Country:US
Mailing Address - Phone:231-935-8800
Mailing Address - Fax:231-935-8801
Practice Address - Street 1:10161 E PICKWICK CT STE E
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5239
Practice Address - Country:US
Practice Address - Phone:231-935-8800
Practice Address - Fax:231-935-8801
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001932213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79276Medicare UPIN
5960680001Medicare NSC
F36404015Medicare ID - Type Unspecified