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NPI Code Detail

MEDICARE: KENTON KYLE MAKI

MEDICARE: KENTON KYLE MAKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMI

General Provider Information

NPI Number : 1205172038
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENTON KYLE MAKI
Provider Business Mailing Address
First Line : 27850 GRATIOT AVE
Second Line :
City : ROSEVILLE
State : MI
Zip : 48066-4803
Country : US
Telephone Number : 586-772-5876
Fax Number : 586-772-5876
Provider Business Practice Location Address
First Line : 27850 GRATIOT AVE
Second Line :
City : ROSEVILLE
State : MI
Zip : 48066-4803
Country : US
Telephone Number : 586-772-5876
Fax Number : 586-772-5876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2012
Last Update Date : 12/26/2012

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Directions to “ KENTON KYLE MAKI ” Practice Location

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