Provider Demographics
NPI:1356234371
Name:HILL, BRYON M
Entity type:Individual
Prefix:
First Name:BRYON
Middle Name:M
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRYON
Other - Middle Name:M
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15448 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1768
Mailing Address - Country:US
Mailing Address - Phone:734-926-7086
Mailing Address - Fax:
Practice Address - Street 1:15448 PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1768
Practice Address - Country:US
Practice Address - Phone:734-926-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI376J00000X, 372600000X, 376K00000X, 385HR2050X, 372500000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205266178Medicaid