Individual
LYLE VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
42180 FORD RD STE 201, CANTON, MI 48187-3676
(734) 844-6075
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301038979
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104530220
—
MI
01
—
290H216580
BLUE SHIELD
MI
Enumeration date
01/23/2006
Last updated
10/22/2020
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