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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