Individual
KYLE JAHMAL BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1968 KENDALL ST, DETROIT, MI 48238-2937
(313) 899-0460
Mailing address
1968 KENDALL ST, DETROIT, MI 48238-2937
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
4704375817
MI
Other
Enumeration date
04/16/2026
Last updated
04/16/2026
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