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General NPI Number Information
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NPI Number | 1558557983
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Entity Type | Organization
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Legal Business Name | SYNTHESIS MEDICAL SPECIALTIES, P.C.
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1 CHATEAUX DU LAC
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City | FENTON
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State | MI
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Zip | 48430-9140
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Country | US
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Telephone | 810-603-3702
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Fax | 810-603-3704
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Provider Business Mailing Address
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Address Line | 1 CHATEAUX DU LAC
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City | FENTON
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State | MI
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Zip | 48430-9140
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Country | US
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Telephone | 810-603-3702
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Fax | 810-603-3704
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW WEISS
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Credential | DO
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Telephone | 810-603-3702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | JN010488
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MW007703
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License Number State | MI
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