Healthcare Provider Details

I. General information

NPI: 1437344587
Provider Name (Legal Business Name): KYLE W PLOEHN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 B DR S SUITE A
BATTLE CREEK MI
49015-9345
US

IV. Provider business mailing address

310 N. MAIN STREET SUITE 301
CHELSEA MI
48118-1807
US

V. Phone/Fax

Practice location:
  • Phone: 269-969-6099
  • Fax:
Mailing address:
  • Phone: 734-222-8200
  • Fax: 734-222-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: