Provider Demographics
NPI:1750551776
Name:JOE SYRIAC
Entity type:Organization
Organization Name:JOE SYRIAC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYRIAC
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-699-7850
Mailing Address - Street 1:40600 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2200
Mailing Address - Country:US
Mailing Address - Phone:248-699-7850
Mailing Address - Fax:248-699-7851
Practice Address - Street 1:40600 8 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2200
Practice Address - Country:US
Practice Address - Phone:248-699-7850
Practice Address - Fax:248-699-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)