Organization
MIYCRNAS LLC
Active
Organization
MIYCRNAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNY LEE CRNA (OWNER)
(248) 797-9839
Entity
Organization
Contact information
Practice address
29201 TELEGRAPH RD, SOUTHFIELD, MI 48034-1331
(281) 248-0028
Mailing address
2351 YORKSHIRE RD, BIRMINGHAM, MI 48009-5919
(248) 797-9839
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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