Provider Demographics
NPI:1902375744
Name:KYTE, SAN MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:SAN
Middle Name:MICHAEL
Last Name:KYTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6633 E GREENWAY PKWY APT 2138
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2053
Mailing Address - Country:US
Mailing Address - Phone:586-405-4511
Mailing Address - Fax:
Practice Address - Street 1:4902 E SHEA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4184
Practice Address - Country:US
Practice Address - Phone:480-214-4468
Practice Address - Fax:480-607-6883
Is Sole Proprietor?:No
Enumeration Date:2018-11-22
Last Update Date:2022-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08571363A00000X
AZ7920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant