Provider Demographics
NPI:1669242103
Name:BYERLY, CARL W (PHD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:BYERLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 OWASCO CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2273
Mailing Address - Country:US
Mailing Address - Phone:810-691-6400
Mailing Address - Fax:248-574-5999
Practice Address - Street 1:6490 EASTLAWN AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2422
Practice Address - Country:US
Practice Address - Phone:810-691-6400
Practice Address - Fax:248-574-5999
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630417869310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility