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NPI Code Detail

MEDICARE: TYRAE MILES

MEDICARE: TYRAE MILES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1902650062
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRAE MILES
Provider Business Mailing Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number : 248-579-5453
Fax Number :
Provider Business Practice Location Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number : 248-579-5453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2024
Last Update Date : 03/23/2026

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Directions to “ TYRAE MILES ” Practice Location

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