Provider Demographics
NPI:1811001589
Name:CWYNAR, DAVID A (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:CWYNAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MICHIGAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1406
Mailing Address - Country:US
Mailing Address - Phone:517-205-7252
Mailing Address - Fax:517-205-7253
Practice Address - Street 1:100 E MICHIGAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1406
Practice Address - Country:US
Practice Address - Phone:517-205-7252
Practice Address - Fax:517-205-7253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501010382OtherPT LIC
MI5501010382OtherPT LIC