Provider Demographics
NPI:1285637165
Name:STRYK, STEVEN VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:VICTOR
Last Name:STRYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1600 S CANTON CENTER RD
Mailing Address - Street 2:STE 360
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-0004
Mailing Address - Country:US
Mailing Address - Phone:734-394-2661
Mailing Address - Fax:734-394-2666
Practice Address - Street 1:1600 S CANTON CENTER RD
Practice Address - Street 2:STE 360
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-0004
Practice Address - Country:US
Practice Address - Phone:734-394-2661
Practice Address - Fax:734-394-2666
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059315207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3466250Medicaid
MI382524087OtherTAX ID #
MIG64157Medicare ID - Type Unspecified
MISS059315OtherSTATE LICENSE #