Individual
JAMA S SY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2142 N COVE BLVD, TOLEDO, OH 43606-3895
(419) 291-2207
(419) 479-6998
Mailing address
2142 N COVE BLVD, TOLEDO, OH 43606-3895
(419) 291-2207
(419) 479-6998
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
M3400
TX
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
35091363
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2833545
—
OH
01
—
48666
HEALTH PLAN OF MICHIGAN
—
Enumeration date
06/14/2006
Last updated
10/03/2008
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