Provider Demographics
NPI:1275612798
Name:TYLEE, LAFAYETTE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LAFAYETTE
Middle Name:MICHAEL
Last Name:TYLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15797 LIME ST.
Mailing Address - Street 2:
Mailing Address - City:HESPERIQ
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3914
Mailing Address - Country:US
Mailing Address - Phone:760-948-5768
Mailing Address - Fax:
Practice Address - Street 1:15080 7TH ST.
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3865
Practice Address - Country:US
Practice Address - Phone:760-243-7330
Practice Address - Fax:760-243-6990
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52123207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine