Provider Demographics
NPI:1689628067
Name:SIANO, JOHN CHARLES JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:SIANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-484-4033
Mailing Address - Fax:517-484-2701
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-4033
Practice Address - Fax:517-484-2701
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI430051450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689628067Medicaid
MI1689628067Medicaid
MIF32365Medicare UPIN