Healthcare Provider Details

I. General information

NPI: 1053053884
Provider Name (Legal Business Name): JOSHUA SZCZEPANSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD ALLEGIANCE HEALTH 205 N EAST AVENUE
JACKSON MI
49201
US

IV. Provider business mailing address

33333 W 12 MILE RD
FARMINGTON HILLS MI
48334-3312
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101029198
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: