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Individual

KILEY ALYSSA BASTIEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
7500 CHALLIS RD, FLOOR 2, BRIGHTON, MI 48116-9416
(734) 936-4054
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007777
MI
363AM0700X
Medical Physician Assistant
5601007777
MI

Other

Enumeration date
06/13/2016
Last updated
12/02/2019
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