Provider Demographics
NPI:1942173380
Name:BUNDLES, TIYE
Entity type:Individual
Prefix:
First Name:TIYE
Middle Name:
Last Name:BUNDLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIYE
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16246 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3314
Mailing Address - Country:US
Mailing Address - Phone:313-399-4970
Mailing Address - Fax:
Practice Address - Street 1:16246 NORMANDY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3314
Practice Address - Country:US
Practice Address - Phone:313-399-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker