Basic Information
| Provider Information | |||||||||
| NPI: | 1053057471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYLE | ||||||||
| FirstName: | LIA | ||||||||
| MiddleName: | ANNA MARINA | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 E HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481094000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346471774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 ARNET ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345395080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4351049212 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.