Provider Demographics
NPI:1275525966
Name:MCINTYRE, SIGMUND O (MD)
Entity Type:Individual
Prefix:DR
First Name:SIGMUND
Middle Name:O
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24911 LITTLE MACK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3200
Mailing Address - Country:US
Mailing Address - Phone:586-447-9071
Mailing Address - Fax:586-447-9081
Practice Address - Street 1:24911 LITTLE MACK AVE STE C
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3200
Practice Address - Country:US
Practice Address - Phone:586-447-9071
Practice Address - Fax:586-447-9081
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301077523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05956677OtherECFMG
MI5315016635OtherCONTROLLED SUBSTANCE
MI17670114Medicaid
BM8797916OtherDEA
05956677OtherECFMG