Healthcare Provider Details

I. General information

NPI: 1457473605
Provider Name (Legal Business Name): IAN FRAZIER LYTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DRIVE SUITE 5001
ANN ARBOR MI
48106
US

IV. Provider business mailing address

5333 MCAULEY DRIVE SUITE 5001
ANN ARBOR MI
48106
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-2323
  • Fax: 734-712-2312
Mailing address:
  • Phone: 734-712-2323
  • Fax: 734-712-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number4301088089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: