Provider Demographics
NPI:1063568772
Name:SZALACH, MICHAEL JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:SZALACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2937
Mailing Address - Country:US
Mailing Address - Phone:716-675-2331
Mailing Address - Fax:716-675-2941
Practice Address - Street 1:1384 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2937
Practice Address - Country:US
Practice Address - Phone:716-675-2331
Practice Address - Fax:716-675-2941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004689213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010256001OtherUNIVERA
NY000511125001OtherBCBS OF WNY
NY000511125001OtherBCBS OF WNY
NY283301Medicare ID - Type Unspecified