Healthcare Provider Details

I. General information

NPI: 1750964110
Provider Name (Legal Business Name): NICOLE ANN BYL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 07/14/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MIDTOWNE ST NE STE 400
GRAND RAPIDS MI
49503-5731
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

V. Phone/Fax

Practice location:
  • Phone: 616-588-1200
  • Fax:
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.077654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: