Healthcare Provider Details

I. General information

NPI: 1851518674
Provider Name (Legal Business Name): EDWARD HENRY SZACHOWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AV. SO. SUITE #508
EDINA MN
55435-4549
US

IV. Provider business mailing address

4999 FRANCE AV. SO. SUITE #210
MINNEAPOLIS MN
55410
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-5665
  • Fax:
Mailing address:
  • Phone: 952-835-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25911
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: