MEDICARE: MR. DAVID SHIHYAO HUANG MA LLP

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	6301012317	MI
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1932313962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID SHIHYAO HUANG MA LLP

Provider Business Mailing Address
First Line	:	650 E BIG BEAVER RD STE A
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1432
Country	:	US
Telephone Number	:	248-910-2626
Fax Number	:	248-649-6780

Provider Business Practice Location Address
First Line	:	650 E BIG BEAVER RD STE A
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1432
Country	:	US
Telephone Number	:	248-910-2626
Fax Number	:	248-649-6780

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	06/02/2012

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