Provider Demographics
NPI:1407013345
Name:BRYCE, RICHARD LINAS (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LINAS
Last Name:BRYCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5635 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-3154
Mailing Address - Country:US
Mailing Address - Phone:313-849-3920
Mailing Address - Fax:313-849-0824
Practice Address - Street 1:5635 W FORT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-3154
Practice Address - Country:US
Practice Address - Phone:313-849-3920
Practice Address - Fax:313-849-0824
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH26239261Medicare UPIN