Healthcare Provider Details

I. General information

NPI: 1831288398
Provider Name (Legal Business Name): DEAN G SIENKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 S CEDAR ST
LANSING MI
48911-3800
US

IV. Provider business mailing address

5303 S CEDAR ST
LANSING MI
48911-3800
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-4428
  • Fax:
Mailing address:
  • Phone: 517-887-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301048740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: