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General NPI Number Information
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NPI Number | 1780526871
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Entity Type | Individual
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Provider Name | KYLE MCKENZIE BA
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Gender | Male
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Dates
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Enumeration Date | 04/07/2026
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Last Update Date | 04/07/2026
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Provider Practice Location Address
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Address Line | 97 CALIFORNIA ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3517
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Country | US
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Telephone | 630-487-0813
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Fax |
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Provider Business Mailing Address
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Address Line | 20260 HUNTINGTON RD
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City | DETROIT
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State | MI
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Zip | 48219-1441
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Country | US
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Telephone | 313-713-4511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | MI
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