Organization
MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC
Active
Organization
MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE ROBERT RANDALL M.D. (PRESIDENT)
(616) 451-9925
Entity
Organization
Contact information
Practice address
2911 KNAPP ST NE, SUITE A, GRAND RAPIDS, MI 49525
(616) 451-9925
(616) 451-9896
Mailing address
2911 KNAPP ST NE, SUITE A, GRAND RAPIDS, MI 49525
(616) 451-9925
(616) 328-5380
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Enumeration date
02/21/2006
Last updated
10/17/2012
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