Individual
KYLE E GORTAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7125 ORCHARD LAKE RD STE 100, WEST BLOOMFIELD, MI 48322-3616
(248) 865-7444
Mailing address
7125 ORCHARD LAKE RD STE 100, WEST BLOOMFIELD, MI 48322-3616
(248) 865-7444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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