Healthcare Provider Details

I. General information

NPI: 1659862449
Provider Name (Legal Business Name): DEBORAH ANN STYS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W GATES ST STE 102
BRUCE TWP MI
48065-4493
US

IV. Provider business mailing address

6307 PRINCETON CT
WASHINGTON MI
48095-1850
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-9696
  • Fax: 586-752-9157
Mailing address:
  • Phone: 586-484-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: