Provider Demographics
NPI:1720978794
Name:SYVERSON, REID SILAS (MSHM)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:SILAS
Last Name:SYVERSON
Suffix:
Gender:M
Credentials:MSHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 MCCOMB RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9755
Mailing Address - Country:US
Mailing Address - Phone:260-633-5868
Mailing Address - Fax:
Practice Address - Street 1:210 W 25TH AVE
Practice Address - Street 2:RM 2024
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408
Practice Address - Country:US
Practice Address - Phone:317-274-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program