Provider Demographics
NPI:1629867973
Name:ROTONDO, KYLE F (FNP-C)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:F
Last Name:ROTONDO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MOCCASIN ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1218
Mailing Address - Country:US
Mailing Address - Phone:312-813-6643
Mailing Address - Fax:312-813-6643
Practice Address - Street 1:1951 OAK ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3738
Practice Address - Country:US
Practice Address - Phone:269-262-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704401501163WE0003X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency