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Individual

DR. JON SPYRIDAKIS I

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
468 CADIEUX RD, GROSSE POINTE, MI 48230-1507
(313) 473-1605
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1848
(947) 522-0307

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101014934
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
02003291A
IN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
5101014934
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000548950
ANTHEM
IN
05
200885280
IN
05
4731380
MI
01
P00606683
RAILROAD MEDICARE
IN
Enumeration date
02/13/2006
Last updated
07/25/2022
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