Provider Demographics
NPI:1154774164
Name:SILVA, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-0000
Mailing Address - Fax:
Practice Address - Street 1:3400 N CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7920
Practice Address - Country:US
Practice Address - Phone:989-583-5574
Practice Address - Fax:989-583-1830
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025959207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine