Kyle Fog

NPI #1013364777 in Walled Lake, Michigan

Provider Information

NPI Number: 1013364777
Entity Type: Individual
Name: Kyle Fog
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: May 23, 2016
Last Updated: May 23, 2016

Practice Location

Address: 620 N PONTIAC TRL
City: Walled Lake
State: Michigan
ZIP Code: 48390-3448
Phone: (248) 669-2776

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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