Healthcare Provider Details

I. General information

NPI: 1922092998
Provider Name (Legal Business Name): DANIEL SESTAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DR
YPSILANTI MI
48197
US

IV. Provider business mailing address

PO BOX 0446 24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR MI
48106-0446
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8676
  • Fax: 734-712-3855
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301406174
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301406174
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: