Healthcare Provider Details

I. General information

NPI: 1770042947
Provider Name (Legal Business Name): KYLE BARJON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N HAGGERTY RD STE 200
CANTON MI
48187-4472
US

IV. Provider business mailing address

6300 N HAGGERTY RD STE 200
CANTON MI
48187-4472
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-8181
  • Fax: 734-981-1259
Mailing address:
  • Phone: 734-981-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101027957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: