Individual
KEITH R WHITLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPSS
Contact information
Practice address
15025 FENKELL ST, DETROIT, MI 48227-2647
(313) 345-4310
Mailing address
15025 FENKELL ST, DETROIT, MI 48227-2647
(313) 345-4310
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/24/2025
Last updated
04/24/2025
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