Individual
KYLE NISWONGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
141 E 12TH ST, HOLLAND, MI 49423-3607
(248) 804-7447
Mailing address
2385 MILLBROOK CT, ROCHESTER HILLS, MI 48306-3144
(248) 804-7447
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/19/2015
Last updated
05/25/2017
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