MEDICARE: LYLE WESLEY CHALKER

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	104100000X	Social Worker	6851120526	MI

General Provider Information

NPI Number	:	1629953096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYLE WESLEY CHALKER

Provider Business Mailing Address
First Line	:	5770 HIGHLAND RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1877
Country	:	US
Telephone Number	:	248-301-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5770 HIGHLAND RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1877
Country	:	US
Telephone Number	:	248-301-1080
Fax Number	:

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

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

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Directions to “ LYLE WESLEY CHALKER ” Practice Location

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