Provider Demographics
NPI:1457473605
Name:LYTLE, IAN FRAZIER (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:FRAZIER
Last Name:LYTLE
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 1:5333 MCAULEY DRIVE
Mailing Address - Street 2:SUITE 5001
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-712-2323
Mailing Address - Fax:734-712-2312
Practice Address - Street 1:5333 MCAULEY DRIVE
Practice Address - Street 2:SUITE 5001
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-712-2323
Practice Address - Fax:734-712-2312
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010880892086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery