Provider Demographics
NPI:1174690523
Name:SYLVAIN, JIM ROLAND (DO)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:ROLAND
Last Name:SYLVAIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-364-5260
Mailing Address - Fax:517-364-5251
Practice Address - Street 1:1200 EAST MICHIGAN AVE STE 520
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1837
Practice Address - Country:US
Practice Address - Phone:517-364-5260
Practice Address - Fax:517-364-5251
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012904208100000X, 208100000X, 208100000X
CA20A7926-MEDICAL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174690523Medicaid
CAG74857Medicare UPIN
MI1174690523Medicaid
MIP23290003Medicare PIN