Provider Demographics
NPI:1386265452
Name:DORAN, KYLE PATRICK (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:PATRICK
Last Name:DORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23521 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2284
Mailing Address - Country:US
Mailing Address - Phone:231-357-1910
Mailing Address - Fax:
Practice Address - Street 1:SPARROW HEALTH SYSTEM
Practice Address - Street 2:1215 E MICHIGAN AVENUE
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014295207P00000X
MI5101027363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine