Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101024167 | MI |
N | 208D00000X | General Practice Physician | 5101025191 | MI |
NPI | 1558855262 |
---|---|
Provider Name | Dr. Kyle Lamont Allan |
First Address | East Lansing, MI 48823-6804 |
Second Address | East Lansing, MI 48823-5376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 02/04/2020 |