Individual
PHILIP KYKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(952) 442-9770
(952) 442-3688
Mailing address
DEPARTMENT 4676, CAROL STREAM, IL 60122-4676
(952) 442-9770
(952) 442-3688
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704135707
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104300186
—
MI
01
—
PK135707
BLUE CROSS OF MI
MI
Enumeration date
12/23/2005
Last updated
02/16/2011
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