Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301117506 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 4301117506 | MI |
NPI | 1326434333 |
---|---|
Provider Name | Tyler Drewry |
First Address | Southfield, MI 48033-3849 |
Second Address | Westland, MI 48186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 22/10/2020 |