Healthcare Provider Details

I. General information

NPI: 1609916469
Provider Name (Legal Business Name): MEDQUAN SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MAIN ST
BRIGHTON MI
48116-1587
US

IV. Provider business mailing address

110 E MAIN ST
BRIGHTON MI
48116-1587
US

V. Phone/Fax

Practice location:
  • Phone: 810-220-8669
  • Fax:
Mailing address:
  • Phone: 810-220-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBI SILJANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 810-220-8600