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NPI Code Detail

MEDICARE: MARY LUCILLE FRYBERGER PICD

MEDICARE:   MARY LUCILLE FRYBERGER  PICD
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
1374J00000XDoulaF616587560716MI

General Provider Information

NPI Number : 1962357491
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LUCILLE FRYBERGER PICD
Provider Business Mailing Address
First Line : 35224 BANBURY CT
Second Line :
City : LIVONIA
State : MI
Zip : 48152-2982
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 35224 BANBURY CT
Second Line :
City : LIVONIA
State : MI
Zip : 48152-2982
Country : US
Telephone Number : 734-395-3616
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ MARY LUCILLE FRYBERGER PICD” Practice Location

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