Provider Demographics
NPI:1184663726
Name:SMITH, KYLE G (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:888 WEST BIG BEAVER RD #1450
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-244-8644
Mailing Address - Fax:248-244-1330
Practice Address - Street 1:888 W BIG BEAVER RD
Practice Address - Street 2:1450
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4736
Practice Address - Country:US
Practice Address - Phone:586-754-3060
Practice Address - Fax:586-627-0027
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51010099752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4738004 11Medicaid
MI4738004 11Medicaid