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NPI Code Detail

MEDICARE: SYLVIA G MUSTONEN DO

MEDICARE: SYLVIA G MUSTONEN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician5101007658MI
2207Q00000XFamily Medicine Physician02003956AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306848619
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYLVIA G MUSTONEN DO
Provider Business Mailing Address
First Line : 804 SERVICE RD
Second Line : #A201
City : EAST LANSING
State : MI
Zip : 48824
Country : US
Telephone Number : 517-884-2976
Fax Number : 517-432-3928
Provider Business Practice Location Address
First Line : 10809 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-2119
Country : US
Telephone Number : 313-824-1000
Fax Number : 313-824-9000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 03/17/2018

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