Healthcare Provider Details

I. General information

NPI: 1336175512
Provider Name (Legal Business Name): JANE K SYRIAC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD SUITE 2190
WEST BLOOMFIELD MI
48323-2184
US

IV. Provider business mailing address

2300 HAGGERTY RD SUITE 2190
WEST BLOOMFIELD MI
48323-2184
US

V. Phone/Fax

Practice location:
  • Phone: 248-960-1122
  • Fax: 248-246-0506
Mailing address:
  • Phone: 248-960-1122
  • Fax: 248-246-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJS058071
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: