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General NPI Number Information
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NPI Number | 1871243931
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Entity Type | Organization
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Legal Business Name | KYLE ANTOSIEK DO PC
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 5680 BOW POINTE DR STE 102
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City | CLARKSTON
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State | MI
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Zip | 48346-5407
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Country | US
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Telephone | 248-221-1845
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Fax | 833-645-2176
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Provider Business Mailing Address
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Address Line | 5680 BOW POINTE DR STE 102
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City | CLARKSTON
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State | MI
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Zip | 48346-5407
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Country | US
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Telephone | 248-221-1845
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Fax | 833-645-2176
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE ANTOSIEK
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Credential | DO
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Telephone | 586-630-6551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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