Individual
MR. MIKE SYRU CHIANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3294 NORTH OAK STREET EXT., VALDOSTA, GA 31605
(229) 241-1188
(229) 245-7106
Mailing address
3294 NORTH OAK STREET EXT, VALDOSTA, GA 31605
(229) 241-1188
(229) 245-7106
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
018627
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000244791B
—
GA
01
—
340005901
MEDICARE RAILROAD
GA
Enumeration date
12/08/2005
Last updated
03/09/2012
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