Healthcare Provider Details

I. General information

NPI: 1861842825
Provider Name (Legal Business Name): KYLE MCDONALD D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MARCELL DR NE STE C
ROCKFORD MI
49341-1362
US

IV. Provider business mailing address

120 MARCELL DR NE STE C
ROCKFORD MI
49341-1362
US

V. Phone/Fax

Practice location:
  • Phone: 616-342-2295
  • Fax: 616-342-2296
Mailing address:
  • Phone: 616-342-2295
  • Fax: 616-342-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101024559
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: