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General NPI Number Information
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NPI Number | 1124001177
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Entity Type | Individual
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Provider Name | MARY SUE J SYLWESTRZAK MD
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 33200 W 14 MILE RD STE 130
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3549
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Country | US
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Telephone | 248-855-4144
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Fax | 248-855-9158
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Provider Business Mailing Address
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Address Line | 33200 W 14 MILE RD STE 130
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3549
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Country | US
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Telephone | 248-855-4144
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Fax | 248-855-9158
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301053077
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License Number State | MI
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