Healthcare Provider Details

I. General information

NPI: 1154792026
Provider Name (Legal Business Name): CHRISTOPHER SYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 ANDREA LN
WEST BLOOMFIELD MI
48322-2122
US

IV. Provider business mailing address

6211 ANDREA LN
WEST BLOOMFIELD MI
48322-2122
US

V. Phone/Fax

Practice location:
  • Phone: 313-587-2930
  • Fax:
Mailing address:
  • Phone: 313-587-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703100401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: