MEDICARE: DR. JEFFREY WAYNE HYDE 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	6301005918	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62-0-F3-4907	OTHER	MI	BCBS OF MI

General Provider Information

NPI Number	:	1841478583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY WAYNE HYDE PH.D

Provider Business Mailing Address
First Line	:	42690 WOODWARD AVE
Second Line	:	SUITE 300
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5062
Country	:	US
Telephone Number	:	248-454-0129
Fax Number	:

Provider Business Practice Location Address
First Line	:	42690 WOODWARD AVE
Second Line	:	SUITE 300
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5062
Country	:	US
Telephone Number	:	248-454-0129
Fax Number	:

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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