Provider Demographics
NPI:1033223201
Name:BYLE, LARRY J (AUD, FAAA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:BYLE
Suffix:
Gender:M
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1951
Mailing Address - Country:US
Mailing Address - Phone:248-608-8881
Mailing Address - Fax:248-608-8879
Practice Address - Street 1:134 W UNIVERSITY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1951
Practice Address - Country:US
Practice Address - Phone:248-608-8881
Practice Address - Fax:248-608-8879
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000068231H00000X
MI3501001544237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI904290689Medicaid
MI640F32642OtherBLUE CROSS IDENTIFIER
MI904290689Medicaid