Provider Demographics
NPI:1275838708
Name:LIFECYCLES OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:LIFECYCLES OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPEIER SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-476-7650
Mailing Address - Street 1:31410 NORTHWESTERN HWY STE A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2563
Mailing Address - Country:US
Mailing Address - Phone:248-476-7650
Mailing Address - Fax:248-702-6188
Practice Address - Street 1:31410 NORTHWESTERN HWY STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2563
Practice Address - Country:US
Practice Address - Phone:248-476-7650
Practice Address - Fax:248-702-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4338737Medicaid
MION24960Medicare PIN
MI4338737Medicaid