Healthcare Provider Details

I. General information

NPI: 1861472797
Provider Name (Legal Business Name): CLYDE R. FLORY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 LEGACY PKWY
LANSING MI
48911-4258
US

IV. Provider business mailing address

4169 LEGACY PKWY
LANSING MI
48911-4258
US

V. Phone/Fax

Practice location:
  • Phone: 517-394-6500
  • Fax: 517-393-4202
Mailing address:
  • Phone: 517-394-6500
  • Fax: 517-393-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberCF024139
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: