Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901017013 | MI |
NPI | 1013976562 |
---|---|
Provider Name | Dr. Lynn C Hyland |
First Address | Kalamazoo, MI 49008-2872 |
Second Address | Kalamazoo, MI 49008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 03/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3289781 | (05) | MI |