Individual
KAILEY EVASIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
55840 GRAND RIVER AVE STE 300, NEW HUDSON, MI 48165-9717
(248) 264-6169
Mailing address
859 WESTBROOKE DR, SOUTH LYON, MI 48178-1667
(248) 504-1486
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601011330
MI
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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