Provider Demographics
NPI:1790787562
Name:SY, DIONISIA ATIENZA (MD)
Entity Type:Individual
Prefix:
First Name:DIONISIA
Middle Name:ATIENZA
Last Name:SY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29828 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1922
Mailing Address - Country:US
Mailing Address - Phone:248-788-9370
Mailing Address - Fax:
Practice Address - Street 1:23050 WEST RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1468
Practice Address - Country:US
Practice Address - Phone:734-671-9800
Practice Address - Fax:734-671-7690
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDS045585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2968364Medicaid
E60412Medicare UPIN