Basic Information
| Provider Information | |||||||||
| NPI: | 1609867043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CYRLIN | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE RD | ||||||||
| Address2: | SUITE 400-CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485946702 | ||||||||
| FaxNumber: | 2485946738 | ||||||||
| Practice Location | |||||||||
| Address1: | 31500 TELEGRAPH RD | ||||||||
| Address2: | STE 005 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485946702 | ||||||||
| FaxNumber: | 2485946738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4301045954 | MI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1439861 | 05 | MI | MEDICAID |