Individual
AUSTIN LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
611 E DOUGLAS RD STE 407, MISHAWAKA, IN 46545-1468
(574) 335-6500
Mailing address
1669 RIVERSIDE DR APT B, SOUTH BEND, IN 46616-1637
(260) 437-7040
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/07/2024
Last updated
05/28/2025
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