MEDICARE: RYLEY WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	363A00000X	Physician Assistant	5601014005	MI

General Provider Information

NPI Number	:	1356046213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLEY WHITE

Provider Business Mailing Address
First Line	:	3440 SOUTH BLVD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1156
Country	:	US
Telephone Number	:	248-979-6852
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 SOUTH BLVD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1156
Country	:	US
Telephone Number	:	248-979-6852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	05/15/2026

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Directions to “ RYLEY WHITE ” Practice Location

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