Provider Demographics
NPI:1336175512
Name:SYRIAC, JANE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:K
Last Name:SYRIAC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 2190
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-960-1122
Mailing Address - Fax:248-246-0506
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 2190
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-960-1122
Practice Address - Fax:248-246-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJS058071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104726344Medicaid
F83217Medicare UPIN
MI104726344Medicaid