Provider Demographics
NPI:1104387976
Name:SAMYN, KYLE M (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:M
Last Name:SAMYN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21980 CRESCENT CT.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335
Mailing Address - Country:US
Mailing Address - Phone:248-477-3603
Mailing Address - Fax:
Practice Address - Street 1:26750 PROVIDENCE PARKWAY SUITE #210
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3472
Practice Address - Country:US
Practice Address - Phone:248-465-4469
Practice Address - Fax:248-465-4503
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program