Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6451019757 | MI |
N | 156F00000X | Technician/Technologist |
NPI | 1275056194 |
---|---|
Provider Name | Adam Ortyl |
First Address | Troy, MI 48084-4400 |
Second Address | Troy, MI 48084-4400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2017 |
Last Update Date | 09/12/2021 |