Individual
TYLER ALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4267 MONROE ST, ECORSE, MI 48229-1519
(313) 236-2881
Mailing address
4267 MONROE ST, ECORSE, MI 48229-1519
(313) 236-2881
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
121773384
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0091158406
BLUE CROSS COMPLETE
MI
Enumeration date
11/18/2015
Last updated
11/18/2015
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