Provider Demographics
NPI:1699250001
Name:FRYC, ROBYN RENEE
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:RENEE
Last Name:FRYC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MACK AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2466
Mailing Address - Country:US
Mailing Address - Phone:313-832-0500
Mailing Address - Fax:313-966-8400
Practice Address - Street 1:311 MACK AVE FL 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2466
Practice Address - Country:US
Practice Address - Phone:313-832-0500
Practice Address - Fax:313-966-8400
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty