MEDICARE: KAIJA MILLER-KYLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1285417691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIJA MILLER-KYLES

Provider Business Mailing Address
First Line	:	12201 W NORTH AVE STE 205
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-2061
Country	:	US
Telephone Number	:	262-777-1729
Fax Number	:

Provider Business Practice Location Address
First Line	:	12201 W NORTH AVE STE 205
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-2061
Country	:	US
Telephone Number	:	262-777-1729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/22/2023

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