Provider Demographics
NPI:1053858217
Name:DR KYLE W SUNDBLAD PC
Entity Type:Organization
Organization Name:DR KYLE W SUNDBLAD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDBLAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-979-0560
Mailing Address - Street 1:41400 DEQUINDRE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD
Practice Address - Street 2:STE 100
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3763
Practice Address - Country:US
Practice Address - Phone:586-731-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty