1750069332 NPI number — MR. SYDNEY MAE GILCHER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750069332 NPI number — MR. SYDNEY MAE GILCHER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILCHER
Provider First Name:
SYDNEY
Provider Middle Name:
MAE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750069332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16700 17MILE RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-522-8586
Provider Business Mailing Address Fax Number:
586-228-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16700 17MILE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-522-8586
Provider Business Practice Location Address Fax Number:
586-228-2300
Provider Enumeration Date:
07/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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