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General NPI Number Information
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NPI Number | 1174909592
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Entity Type | Organization
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Legal Business Name | IAN LYTLE MD PC
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 18181 OAKWOOD BLVD SUITE 200
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City | DEARBORN
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State | MI
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Zip | 48124-5032
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Country | US
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Telephone | 313-399-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 18181 OAKWOOD BLVD SUITE 200
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City | DEARBORN
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State | MI
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Zip | 48124-5032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. IAN FRAZIER LYTLE
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Credential | MD
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Telephone | 313-399-9775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 4301088089
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License Number State | MI
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