Healthcare Provider Details

I. General information

NPI: 1427109149
Provider Name (Legal Business Name): COREEN DIAN GARCIA-SWEETS P.A.,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COREEN DIAN GARCIA P.A.,C

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 E MICHIGAN AVE STE 100
JACKSON MI
49202-3971
US

IV. Provider business mailing address

3235 E MICHIGAN AVE STE 100
JACKSON MI
49202-3971
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3280
  • Fax: 517-787-9680
Mailing address:
  • Phone: 517-205-3280
  • Fax: 517-205-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601005657
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: