Healthcare Provider Details

I. General information

NPI: 1790630341
Provider Name (Legal Business Name): TYRICE PONDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28040 ROSEWOOD ST
INKSTER MI
48141-1793
US

IV. Provider business mailing address

28040 ROSEWOOD ST
INKSTER MI
48141-1793
US

V. Phone/Fax

Practice location:
  • Phone: 313-713-9590
  • Fax:
Mailing address:
  • Phone: 313-713-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: