Healthcare Provider Details

I. General information

NPI: 1922340033
Provider Name (Legal Business Name): SCOTT ALEXANDER SISKIND MBBCHBAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOGBACK RD SUITE 1
ANN ARBOR MI
48105-9750
US

IV. Provider business mailing address

2006 HOGBACK RD SUITE 1
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 734-786-2300
  • Fax: 734-786-4915
Mailing address:
  • Phone: 734-786-2300
  • Fax: 734-786-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA147471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: