Healthcare Provider Details

I. General information

NPI: 1811079122
Provider Name (Legal Business Name): STEPHEN SZYNAL DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 WINSTED DR
GOSHEN IN
46526-4655
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-8794
  • Fax:
Mailing address:
  • Phone: 317-802-6311
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SZYNAL
Title or Position: OWNER
Credential: DO
Phone: 574-534-8794