| Doctor Name: | SILAS JOB DEBACKER |
| NPI Number: | 1609223841 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 5101022419 |
| Business Practice Address: | 12000 E 12 Mile Rd Department Of Medical Education Warren, MI - 480933570 |
| Business Phone Number: | 5865764140 |
| Business Fax Number: | 5865764146 |
| Mailing Address: | 12000 E 12 Mile Rd, Department Of Medical Education WARREN |
| State: | MI |
| Postal Code: | 480933570 |
| Phone Number: | 5865764140 |
| Fax Number: | 5865764146 |
| NPI Enumeration Date: | 05/18/2016 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101022419 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |