Healthcare Provider Details

I. General information

NPI: 1780107110
Provider Name (Legal Business Name): MATTHEW SZUBELAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 STONY CREEK RD
YPSILANTI MI
48197-9343
US

IV. Provider business mailing address

8010 STONY CREEK RD
YPSILANTI MI
48197-9343
US

V. Phone/Fax

Practice location:
  • Phone: 586-612-9006
  • Fax:
Mailing address:
  • Phone: 586-612-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401002007
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: