Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1245872118 |
---|---|
Provider Name | Mrs. Kyra Canada |
First Address | Southfield, MI 48034-2080 |
Second Address | Southfield, MI 48034-2080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2019 |
Last Update Date | 11/10/2019 |