Healthcare Provider Details

I. General information

NPI: 1932095726
Provider Name (Legal Business Name): SYDNEY TAYLOR KURTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 TAFT ST
ROMULUS MI
48174-3233
US

IV. Provider business mailing address

15545 TAFT ST
ROMULUS MI
48174-3233
US

V. Phone/Fax

Practice location:
  • Phone: 734-740-1727
  • Fax:
Mailing address:
  • Phone: 734-740-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number2601003314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: