Healthcare Provider Details

I. General information

NPI: 1407528136
Provider Name (Legal Business Name): KYLE MICHAEL MCINTOSH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 PLYMOUTH RD
ANN ARBOR MI
48105-9520
US

IV. Provider business mailing address

5331 PLYMOUTH RD
ANN ARBOR MI
48105-9520
US

V. Phone/Fax

Practice location:
  • Phone: 734-412-7300
  • Fax:
Mailing address:
  • Phone: 734-412-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801111165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: