Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 58850 | TN |
NPI | 1003104639 |
---|---|
Provider Name | Mr. Michael Alexander Sywak |
First Address | Waterbury, CT 06704-1942 |
Second Address | Cookeville, TN 38501-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 06/01/2020 |