Provider Demographics
NPI:1154502623
Name:GANDY, KYLE DAVID (PA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:GANDY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2935 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8931
Mailing Address - Country:US
Mailing Address - Phone:989-779-5259
Mailing Address - Fax:989-779-5293
Practice Address - Street 1:2935 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8931
Practice Address - Country:US
Practice Address - Phone:989-779-5259
Practice Address - Fax:989-779-5293
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005166363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical