Healthcare Provider Details

I. General information

NPI: 1578268165
Provider Name (Legal Business Name): KYLE AUSTIN GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MICHIGAN ST NE FL 8
GRAND RAPIDS MI
49503-2531
US

IV. Provider business mailing address

275 MICHIGAN ST NE FL 8
GRAND RAPIDS MI
49503-2531
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-6243
  • Fax: 616-391-8612
Mailing address:
  • Phone: 616-391-6243
  • Fax: 616-391-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number4351051118
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: