KYLE FOG
NPI 1013364777
Student in an Organized Health Care Education/Training Program in Walled Lake, MI

Active since May 23, 2016
620 N PONTIAC TRL, WALLED LAKE, MI 48390(248) 669-2776 Get Directions Write a Review

NPPES record last updated: May 23, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kyle Fog NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KYLE FOG (NPI 1013364777) is an individual student in an organized health care education/training program in Walled Lake, Michigan, licensed in Michigan (5302041191) and active in the NPI registry since May 2016.

NPPES Registry Identity

NPI1013364777
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameKYLE FOG
Location Address620 N PONTIAC TRLWalled Lake, MI 48390-3448
Mailing Address620 N Pontiac TrlWalled Lake, MI 48390-3448 · (248) 669-2776
Sole ProprietorYes
Enumeration DateMay 23, 2016
NPI 1013364777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
License Licensed in MI · 5302041191
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
620 N PONTIAC TRL, Walled Lake, MI 48390

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pharmacy Technician
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Pharmacist
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Pharmacist
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Nurse Practitioner (Family)
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Physician Assistant
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Physician Assistant
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Pharmacist
620 N PONTIAC TRL
WALLED LAKE, MI 48390
Pharmacist
620 N PONTIAC TRL
WALLED LAKE, MI 48390

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kyle Fog's NPI number?

The NPI number for Kyle Fog is 1013364777. It was assigned to this individual provider in the NPPES registry on May 23, 2016.

Where is Kyle Fog located?

Kyle Fog practices at 620 N Pontiac Trl, Walled Lake, MI 48390. The listed phone number is (248) 669-2776.

What is Kyle Fog's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Kyle Fog was last updated on May 23, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.