Individual
SEAN M. PRYSTASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-9106
(313) 916-1249
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-9106
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301077904
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
487476810
—
MI
01
—
7509105550
BLUE CROSS-BLUE CROSS
—
01
—
SP077904
CHAMPUS-CHAMPUS
—
Enumeration date
07/12/2006
Last updated
12/22/2021
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