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General NPI Number Information
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NPI Number | 1780686469
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Entity Type | Organization
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Legal Business Name | GUAT SY JR MD PC
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 17000 HUBBARD DR STE 700
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City | DEARBORN
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State | MI
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Zip | 48126-4205
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Country | US
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Telephone | 313-271-2990
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Fax | 313-271-1698
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Provider Business Mailing Address
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Address Line | 17000 HUBBARD DR STE 700
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City | DEARBORN
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State | MI
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Zip | 48126-4205
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Country | US
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Telephone | 313-271-2990
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Fax | 313-271-1698
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GUAT SIA SY JR.
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Credential | MD
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Telephone | 313-271-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301040071
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 4301040071
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License Number State | MI
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