Basic Information
| Provider Information | |||||||||
| NPI: | 1851940167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYCHUK | ||||||||
| FirstName: | DARBY | ||||||||
| MiddleName: | KATHERINE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28624 OAKMONT CT | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483312995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487556520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17800 NEWBURGH RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344649540 | ||||||||
| FaxNumber: | 7344640438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2019 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 5601009512 | 01 | MI | PHYSICIAN LICENSE | OTHER |