Provider Demographics
NPI:1538109293
Name:SIERANT, JOHN X (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:X
Last Name:SIERANT
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 1:19353 CARLYSLE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3802
Mailing Address - Country:US
Mailing Address - Phone:313-565-9000
Mailing Address - Fax:313-565-1086
Practice Address - Street 1:19353 CARLYSLE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3802
Practice Address - Country:US
Practice Address - Phone:313-565-9000
Practice Address - Fax:313-565-1086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0821105Medicare ID - Type Unspecified
B44751Medicare UPIN