Provider Demographics
NPI:1841272085
Name:SIRLS, LARRY T II (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:T
Last Name:SIRLS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31157 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0926
Mailing Address - Country:US
Mailing Address - Phone:248-336-0123
Mailing Address - Fax:248-336-3190
Practice Address - Street 1:31157 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0926
Practice Address - Country:US
Practice Address - Phone:248-336-0123
Practice Address - Fax:248-336-3190
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051684208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI131681OtherPREFERRED CHOICES
MI340012686OtherRAILROAD MEDICARE
MI4576948OtherAETNA
MIF56498OtherHAP
MI4202425Medicaid
MIC7402OtherMCARE
MILS051684OtherBCBSM OTHER IDENTIFIER
F56498Medicare UPIN
MIP41310007Medicare ID - Type Unspecified