Provider Demographics
NPI:1225019854
Name:SYRON, SHAWN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:P
Last Name:SYRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3609
Mailing Address - Country:US
Mailing Address - Phone:248-997-9700
Mailing Address - Fax:248-997-9707
Practice Address - Street 1:2940 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3609
Practice Address - Country:US
Practice Address - Phone:248-997-9700
Practice Address - Fax:248-997-9707
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON28940Medicare ID - Type Unspecified
H35626Medicare UPIN
MI0N74000Medicare PIN