Healthcare Provider Details

I. General information

NPI: 1164575833
Provider Name (Legal Business Name): EDWARD JOSEPH SZUMOWSKI AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4232 29TH ST SE
GRAND RAPIDS MI
49512-1936
US

IV. Provider business mailing address

4232 29TH ST SE
GRAND RAPIDS MI
49512-1936
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-1818
  • Fax: 616-942-6567
Mailing address:
  • Phone: 616-942-1818
  • Fax: 616-942-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: