Provider Demographics
NPI:1356465751
Name:LYTLE MEDICAL TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:LYTLE MEDICAL TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARILYN
Authorized Official - Middle Name:RENAY
Authorized Official - Last Name:LYTLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSEE, MBA
Authorized Official - Phone:248-444-6626
Mailing Address - Street 1:33228 W 12 MILE RD # 327
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3309
Mailing Address - Country:US
Mailing Address - Phone:248-626-3100
Mailing Address - Fax:248-626-3113
Practice Address - Street 1:34119 W 12 MILE RD STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331
Practice Address - Country:US
Practice Address - Phone:248-626-3100
Practice Address - Fax:248-626-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5879860001Medicare NSC