Healthcare Provider Details

I. General information

NPI: 1053518373
Provider Name (Legal Business Name): LYLE D. VICTOR, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18101 OAKWOOD BLVD
DEARBORN MI
48124-4089
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-8620
  • Fax: 313-593-8551
Mailing address:
  • Phone: 313-436-2581
  • Fax: 313-436-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number4301038979
License Number StateMI

VIII. Authorized Official

Name: DR. LYLE D VICTOR
Title or Position: PHYSICIAN
Credential: MD, MBA
Phone: 313-436-2581