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Kyle Fog
Student in an Organized Health Care Education/Training Program in Walled Lake, Michigan
NPI 1013364777

Kyle Fog is a Student in an Organized Health Care Education/Training Program based in Walled Lake, MI. Kyle Fog practices in Walled Lake, MI. The NPI Number for Kyle Fog is 1013364777 and holds a License No. 5302041191 (Michigan).

The current practice location address for Kyle Fog is 620 N Pontiac Trl, Walled Lake, MI and can be reached out via phone at 248-669-2776.

Location: 620 N Pontiac Trl, Walled Lake, MI, 48390-3448
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013364777
Provider Name
Kyle Fog
Credential
Provider Entity Type
Individual
Gender
Male
Address
620 N Pontiac Trl, Walled Lake, MI, 48390-3448
Phone Number
248-669-2776
Fax Number
Provider Enumeration Date
05/23/2016
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
620 N Pontiac Trl
City
Walled Lake
State
Michigan
Zip
48390-3448
Phone Number
248-669-2776
Fax Number
person
Provider Business Mailing Address Details
Address
620 N Pontiac Trl
City
Walled Lake
State
Michigan
Zip
48390-3448
Phone Number
248-669-2776
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
5302041191 (Michigan)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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