MEDICARE: MARI LYNN SYSAK BS

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	237700000X	Hearing Instrument Specialist	00002594	MI

General Provider Information

NPI Number	:	1932324415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI LYNN SYSAK BS

Provider Business Mailing Address
First Line	:	31503 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082
Country	:	US
Telephone Number	:	586-294-9887
Fax Number	:	586-469-1316

Provider Business Practice Location Address
First Line	:	31503 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082-2455
Country	:	US
Telephone Number	:	586-294-9887
Fax Number	:	586-469-1316

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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