Healthcare Provider Details

I. General information

NPI: 1083187801
Provider Name (Legal Business Name): KYLE MAYOTTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3 MILE RD NW STE 200
GRAND RAPIDS MI
49544-1691
US

IV. Provider business mailing address

600 3 MILE RD NW STE 200
GRAND RAPIDS MI
49544-1691
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 855-832-6727
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: