MEDICARE: KYLE BENJAMIN TIFFANY

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
1	172V00000X	Community Health Worker		MI

General Provider Information

NPI Number	:	1518898725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE BENJAMIN TIFFANY

Provider Business Mailing Address
First Line	:	4925 S MAIN ST
Second Line	:
City	:	LESLIE
State	:	MI
Zip	:	49251-9434
Country	:	US
Telephone Number	:	517-819-3290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N WEST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2179
Country	:	US
Telephone Number	:	517-539-5856
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ KYLE BENJAMIN TIFFANY ” Practice Location

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