Healthcare Provider Details

I. General information

NPI: 1396851366
Provider Name (Legal Business Name): LARRY FRANCIS CARLYON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 N. MAIN ST.
LANSE MI
49946-1126
US

IV. Provider business mailing address

7 CHILMAN LN
ISHPEMING MI
49849-9759
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-3435
  • Fax: 906-524-5466
Mailing address:
  • Phone: 906-485-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number040361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: