Healthcare Provider Details

I. General information

NPI: 1134248644
Provider Name (Legal Business Name): KIRK SAID ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 VAN BORN RD
TAYLOR MI
48180-1340
US

IV. Provider business mailing address

21001 VAN BORN RD
TAYLOR MI
48180-1340
US

V. Phone/Fax

Practice location:
  • Phone: 313-792-6155
  • Fax:
Mailing address:
  • Phone: 313-792-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: