Provider Demographics
NPI:1306848619
Name:MUSTONEN, SYLVIA G (DO)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:G
Last Name:MUSTONEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:#A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:10809 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2119
Practice Address - Country:US
Practice Address - Phone:313-824-1000
Practice Address - Fax:313-824-9000
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007658207Q00000X
IN02003956A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34008500Medicaid
MI1306848619Medicaid
WI34008500Medicaid
MI1306848619Medicaid