Healthcare Provider Details

I. General information

NPI: 1770718660
Provider Name (Legal Business Name): MICHAEL THEODORE SALWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JACK FOSTER DR
SHENANDOAH IA
51601-4586
US

IV. Provider business mailing address

300 PERSHING AVE
SHENANDOAH IA
51601-2355
US

V. Phone/Fax

Practice location:
  • Phone: 712-246-7400
  • Fax: 712-246-7334
Mailing address:
  • Phone: 712-246-1230
  • Fax: 712-246-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43914
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: