Provider Demographics
NPI:1134626369
Name:KONDRAT, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KONDRAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4627
Mailing Address - Fax:
Practice Address - Street 1:350 HERITAGE WAY STE 1100
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3160
Practice Address - Country:US
Practice Address - Phone:406-752-8900
Practice Address - Fax:406-752-8909
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT155509207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology