MEDICARE: DR. LYNDA S. GILES PH.D.

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	103TC0700X	Clinical Psychologist	6301007735	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	029974	OTHER	MI	VALUE OPTIONS
2	68OF33184	OTHER	MI	BLUE CROSS, PSYCHOLOGIST
3	7937108	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1538225669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNDA S. GILES PH.D.

Provider Business Mailing Address
First Line	:	6300 WESTMOOR RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-1359
Country	:	US
Telephone Number	:	248-932-8899
Fax Number	:	248-851-1815

Provider Business Practice Location Address
First Line	:	6300 WESTMOOR RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-1359
Country	:	US
Telephone Number	:	248-932-8899
Fax Number	:	248-851-1815

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

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	07/08/2007

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