Individual
KYLE DONALD MINAUDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2243 E 12 MILE RD, WARREN, MI 48092-5644
(586) 573-8100
(586) 573-8101
Mailing address
2243 E 12 MILE RD, WARREN, MI 48092-5644
(586) 573-8100
(586) 573-8101
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501014287
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497708200
MEDICARE
TX
Enumeration date
06/16/2021
Last updated
06/16/2021
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