Healthcare Provider Details

I. General information

NPI: 1053211870
Provider Name (Legal Business Name): CONOR PRZYBYLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MADISON ST
ADRIAN MI
49221-2518
US

IV. Provider business mailing address

42940 VERSAILLES RD
CANTON MI
48187-2344
US

V. Phone/Fax

Practice location:
  • Phone: 517-265-5161
  • Fax:
Mailing address:
  • Phone: 734-546-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: