Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01078562A | IN |
Y | 208600000X | Surgeon | 01078562A | IN |
N | 208200000X | Surgeon | 4301101178 | MI |
N | 208600000X | Surgeon | 4301101178 | MI |
NPI | 1003178898 |
---|---|
Provider Name | Kyle Norris Seudeal |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 20/03/2021 |