Healthcare Provider Details

I. General information

NPI: 1699611202
Provider Name (Legal Business Name): EDWARD KEVIN CONTI SIATON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15646 ST JAMES ST
MACOMB MI
48044-1513
US

IV. Provider business mailing address

15646 ST JAMES ST
MACOMB MI
48044-1513
US

V. Phone/Fax

Practice location:
  • Phone: 586-344-0026
  • Fax:
Mailing address:
  • Phone: 586-344-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704296731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: