Individual
KAYLEE MARIE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-3281
Mailing address
5801 KINGSFIELD DR, WEST BLOOMFIELD, MI 48322-1479
(585) 754-0202
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
016201
NY
363A00000X
Physician Assistant
Primary
5601007727
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016201
LICENSE
NY
01
—
1104144
NCCPA
NY
Enumeration date
11/05/2012
Last updated
03/16/2018
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