MEDICARE: DR. KATALIN B SZLOBODA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301067558	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1101600251	OTHER	MI	INDIVIDUAL BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	110A610070	OTHER	MI	GROUP BLUE CROSS

General Provider Information

NPI Number	:	1760415830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATALIN B SZLOBODA M.D.

Provider Business Mailing Address
First Line	:	1400 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-9526
Country	:	US
Telephone Number	:	906-265-6121
Fax Number	:	906-265-4245

Provider Business Practice Location Address
First Line	:	1328 US HIGHWAY 2
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-1045
Country	:	US
Telephone Number	:	906-875-4486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/27/2013

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