Healthcare Provider Details

I. General information

NPI: 1083572770
Provider Name (Legal Business Name): EVAN FRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 S OLD US 23 STE 100
BRIGHTON MI
48116-7524
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR STE J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 810-494-6885
  • Fax: 810-494-6839
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013942
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: