Healthcare Provider Details

I. General information

NPI: 1548378797
Provider Name (Legal Business Name): JOSEPH PATRICK SYPNIEWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST SUITE 210
PETOSKEY MI
49770-2275
US

IV. Provider business mailing address

560 W MITCHELL ST SUITE 210
PETOSKEY MI
49770-2275
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-2340
  • Fax: 231-487-2115
Mailing address:
  • Phone: 231-487-2340
  • Fax: 231-487-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101009544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: