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NPI Code Detail

MEDICARE: STANLEY LARRY

MEDICARE: STANLEY LARRY
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
1172V00000XCommunity Health WorkerMI

General Provider Information

NPI Number : 1568334472
Entity Type Code : Individual
Provider Name (Legal Business Name) : STANLEY LARRY
Provider Business Mailing Address
First Line : 14056 ASHTON RD
Second Line :
City : DETROIT
State : MI
Zip : 48223-3532
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8633 SOUTHFIELD FWY
Second Line :
City : DETROIT
State : MI
Zip : 48228-1975
Country : US
Telephone Number : 313-804-8635
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2025
Last Update Date : 09/19/2025

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Directions to “ STANLEY LARRY ” Practice Location

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