Provider Demographics
NPI:1114929791
Name:SY, GUAT SIA JR (MD)
Entity type:Individual
Prefix:
First Name:GUAT
Middle Name:SIA
Last Name:SY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:17000 HUBBARD DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4258
Mailing Address - Country:US
Mailing Address - Phone:313-271-2990
Mailing Address - Fax:313-271-1698
Practice Address - Street 1:17000 HUBBARD DR
Practice Address - Street 2:SUITE 700
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4258
Practice Address - Country:US
Practice Address - Phone:313-271-2990
Practice Address - Fax:313-271-1698
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040071208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114929791Medicaid
MI020010746OtherRAILROAD MEDICARE
MI2929938-10Medicaid
MIB45647OtherHAP
MI0208269691OtherBCBS PIN
MI4079900OtherAETNA
MIP00753351OtherRAILROAD MEDICARE
MI1114929791Medicaid
MI0208269691OtherBCBS PIN