Individual
MR. BLAINE MICHAEL KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 N JOHN R WOODEN DR, WEST LAFAYETTE, IN 47907-2117
(800) 497-7678
Mailing address
3426 WAVERLY DR, LAFAYETTE, IN 47909-7320
(765) 414-9245
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/28/2020
Last updated
05/26/2023
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