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General NPI Number Information
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NPI Number | 1134283633
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Entity Type | Organization
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Legal Business Name | WASHTENAW UROLOGY CLINIC PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 1010 BURR STREET
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City | JACKSON
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State | MI
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Zip | 49201
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Country | US
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Telephone | 517-782-7474
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Fax | 517-782-2128
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Provider Business Mailing Address
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Address Line | 1010 BURR STREET
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City | JACKSON
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State | MI
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Zip | 49201
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Country | US
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Telephone | 517-782-7474
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Fax | 517-782-2128
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN P SYKES
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Credential | MD
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Telephone | 517-782-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | JS056395
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License Number State | MI
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