Individual
KYLE A RASIKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-5000
Mailing address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-1800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301041661
MI
208M00000X
Hospitalist Physician
Primary
4301041661
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104100571
BCBS OF MICHIGAN
MI
01
—
38-2145264
IRS TAX ID# THRU CORP
—
05
—
4260170
—
MI
Enumeration date
08/24/2006
Last updated
05/17/2022
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