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General NPI Number Information
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NPI Number | 1720063100
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Entity Type | Individual
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Provider Name | MIKE SYRU CHIANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 3294 NORTH OAK STREET EXT.
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City | VALDOSTA
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State | GA
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Zip | 31605
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Country | US
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Telephone | 229-241-1188
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Fax | 229-245-7106
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Provider Business Mailing Address
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Address Line | 3294 NORTH OAK STREET EXT
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City | VALDOSTA
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State | GA
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Zip | 31605
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Country | US
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Telephone | 229-241-1188
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Fax | 229-245-7106
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 018627
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License Number State | GA
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