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General NPI Number Information
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NPI Number | 1205286267
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Entity Type | Individual
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Provider Name | MEGAN BOYLE
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Gender | Female
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 17183 GRIGGS ST
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City | DETROIT
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State | MI
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Zip | 48221-2426
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Country | US
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Telephone | 650-255-4547
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Fax |
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Provider Business Mailing Address
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Address Line | 17301 LIVERNOIS AVE STE 929
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City | DETROIT
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State | MI
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Zip | 48221-2758
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Country | US
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Telephone | 650-255-4547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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